Predictors of Fetal and Maternal Outcome in the Crucible of Hepatic Dysfunction During Pregnancy

Abstract

BackgroundHepatic dysfunction during pregnancy places both the mother and the fetus at risk. Investigations which are efficient, cost effective and easily available for prognostication are required to tackle this global problem. We studied the etiologies and evaluated investigations for predictive efficiency.MethodsOne hundred ninety-seven pregnant women with hepatic dysfunction during pregnancy were identified. All patients were followed up till 8 weeks after termination of pregnancy or death. Clinico-demographic, biochemical and hematological data were collected and analyzed.ResultsOne hundred ninety-seven of 6,122 females had abnormal liver function tests. Pre-eclampsia (57%), eclampsia (19%), HELLP syndrome (8%), viral infection (6%), hyperemesis gravidarum (5%), intrahepatic cholestasis of pregnancy (4%), chronic liver disease (1%) and sepsis were encountered. There were 41 fetal deaths, 42% preterm deliveries, and NICU admission rate was 27%. Five maternal deaths occurred. Maternal anemia, thrombocytopenia, hyperbilirubinemia and coagulopathy were statistically significant in adverse fetal outcomes. Serum bilirubin performed better than INR as a predictor of both maternal and fetal outcomes.ConclusionsHepatic dysfunction during pregnancy is associated with adverse events for both the mother and the fetus and hypertensive disorders remain the major cause. Maternal bilirubin levels and INR have a role in predicting adverse feto-maternal outcome.

Maternal and Fetal Outcome in Intrahepatic Cholestasis of Pregnancy in a Multicultural Society Conducted at a Tertiary Care Hospital in Dubai

“…There are physiological and biochemical changes in liver functions which are needed to support the growing fetus. Any abnormal change needs to be differentiated from physi-DOI: 10.1159/000513717 ological change as liver dysfunction has adverse implications on the mother and fetus [1]. Jaundice and pruritus are few of the manifestations of liver disease and occur in 1 in 2000 pregnancies [2].…”

Foetal Outcomes in Pregnancies with Hepatic Dysfunction

“…Maximum incidence of liver disease complicating pregnancy occurred between 21-25 years as in previous reports. 7,8 Pregnancy specific hepatic dysfunction was the most frequent cause for liver disease in this study (66%). Among this HELLP contributed mostly to hepatic dysfunction in 21% and hyperemesis gravidarum and preeclampsia 12% each.…”

The Most Important Factors in Prognosis Of Obstetric Patients with Disseminated Intravascular Coagulation: A Tertiary Center Study

“…For these reasons, patients are monitored for spontaneous labor. However, within this period, the patients have an increased risk of coagulopathy and may develop chronic coagulopathy 14,15 . In our study, the most common cause of DIC was postpartum hemorrhage, followed by hypertensive pregnancies, ablatio placentae, and other conditions.…”