An Observational Study to Evaluate the Maternal and Foetal Outcomes in Pregnancies Complicated with Jaundice

  • Pradnya ChangedeEmail author
  • Niranjan Chavan
  • Neha Raj
  • Priyanka Gupta
Original Article



Incidence of jaundice in pregnancy, including underlying chronic liver diseases, is 3–5%. However, the maternal mortality rate in some conditions can be as high as 18% in acute fatty liver of pregnancy and 22% in hepatitis E in pregnancy.


This is an observational study of the demographics, obstetrical profile, aetiology, maternal morbidity, mortality and neonatal outcomes in pregnancies complicated with jaundice.

Materials and Methods

This is an observational study conducted in Department of Obstetrics and Gynaecology of a tertiary care hospital, situated amidst the biggest urban slum in Mumbai spanning over 1 year from January 2016 to December 2016. All registered, unregistered and transferred patients with abnormal liver function tests excluding patients with chronic liver diseases were included in this study.


Most of the cases of jaundice in pregnancy were seen in primigravida (51%) and age group of 20–30 years (58%). Fifty-three percentage of cases were referred or transferred from periphery hospitals. Hepatitis E was the most common cause (42%) of jaundice in pregnancy. Complications like disseminated intravenous coagulopathy, postpartum haemorrhage, hepatic encephalopathy and hepatoportal hypertension were seen in 65% of cases. Maternal mortality rate and perinatal mortality rate were as high as 40 and 37%, respectively, in our study.


Incidence of jaundice in pregnancy, mainly due to viral hepatitis, is very high in lower socio-economic, densely populated urban slums. Special efforts should be made to counsel and educate the mothers about initial symptoms and preventive measures for viral hepatitis. Patients along with the relatives should be informed about the severe features of pre-eclampsia to combat these preventable causes of maternal mortality.


Jaundice Hepatitis E Maternal mortality Preventable 


Compliance with Ethical Standards

Conflict of interest


Ethical Standards

All procedures performed were with the standard of institutional research ethical committee and the 1964 Helsinki declaration and its later amendments.


  1. 1. Assessed 28 Sept 2017.
  2. 2.
    Celik H, Tosun M, Cetinkaya MB, et al. Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy. J Matern Fetal Neonatal Med. 2009;22(8):705–7. Scholar
  3. 3.
    Hay JE. Liver disease in pregnancy. Hepatology. 2008;47(3):1067–76. Scholar
  4. 4.
    Nandi B, Hadimani P, Arunachalam R, et al. Spectrum of acute viral hepatitis in Southern India. Med J Armed Forces India. 2009;65(1):7–9. Scholar
  5. 5.
    Fares A. Seasonality of hepatitis: a review update. J Fam Med Prim Care. 2015;4(1):96–100. Scholar
  6. 6.
    Chaudhry SA, Verma N, Koren G. Hepatitis E infection during pregnancy. Can Fam Physician. 2015;61(7):607–8.Google Scholar
  7. 7.
    Zhang Y-P, Kong W-Q, Zhou S-P, et al. Acute fatty liver of pregnancy: a retrospective analysis of 56 cases. Chin Med J. 2016;129(10):1208–14. Scholar
  8. 8.
    Jeyabalan A. Epidemiology of preeclampsia: impact of obesity. Nutr Rev. 2013. Scholar
  9. 9.
    Ellington SR, Flowers L, Legardy-Williams JK, et al. Recent trends in hepatic diseases during pregnancy in the United States, 2002–2010. Am J Obstet Gynecol. 2015;212(4):524.e1-7. Scholar
  10. 10.
    Krishnamoorthy J, Murugesan A. Jaundice during pregnancy-maternal and fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2016;5:2541–5.CrossRefGoogle Scholar
  11. 11.
    Aparajita D. Maternal and fetal outcome in liver diseases of pregnancy—a tertiary hospital experience. Int J Sci Res Publ. 2015;5(9):1–4.Google Scholar
  12. 12.
    English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control. 2015;8:7–12. Scholar
  13. 13.
    Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol. 2016;64(4):933–45. Scholar
  14. 14.
    Devarbhavi H, Kremers WK, Dierkhising R, et al. Pregnancy associated acute liver disease and acute viral hepatitis: differentiation, course and outcome. J Hepatol. 2008;49:930–5.CrossRefGoogle Scholar
  15. 15.
    Devi SG, Kumar A, Kar P, et al. Association of pregnancy outcome with cytokine gene polymorphisms in HEV infection during pregnancy. J Med Virol. 2014;86(8):1366–76.CrossRefGoogle Scholar
  16. 16.
    Society for Maternal-Fetal Medicine (SMFM), Dionne-Odom J, Tita AT, Silverman NS. #38: hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214:6.CrossRefGoogle Scholar
  17. 17.
    Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335–74.CrossRefGoogle Scholar
  18. 18.
    American College of Obstetricians and Gynecologists. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstet Gynecol. 2013;122:1122.CrossRefGoogle Scholar
  19. 19.
    Eskelin PM, Laitinen KA, Tyni TA. Elevated hydroxyacylcarnitines in a carrier of LCHAD deficiency during acute liver disease of pregnancy—a common feature of the pregnancy complication? Mol Genet Metab. 2010;100(2):204–6.CrossRefGoogle Scholar
  20. 20.
    Kremer AE, Oude Elferink RP, Beuers U. Pathophysiology and current management of pruritus in liver disease. Clin Res Hepatol Gastroenterol. 2011;35:89.CrossRefGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2018

Authors and Affiliations

  • Pradnya Changede
    • 1
    Email author
  • Niranjan Chavan
    • 1
  • Neha Raj
    • 1
  • Priyanka Gupta
    • 1
  1. 1.Department of Obstetrics and GynaecologyLokmanya Tilak Municipal Medical CollegeSion, MumbaiIndia

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