To Prevent Jaundice in Pregnancy Today

Abstract

Aim To find out, best measures for the prevention of jaundice in pregnancy.

Settings A large public tertiary referral Centre for Obstetric care in Chennai Metropolis. Materials and Methods Case records of all antenatal mothers with jaundice in any trimester of pregnancy attending the hospital over a period of 1 year, were analysed to find out best measures for early detection and prevention of jaundice in pregnancy.

Results There were a total number of 17,890 antenatal admissions during the study period and 51 pregnant women with jaundice were admitted for treatment. The incidence of jaundice complicating pregnancy during this period in our hospital was 0.29%. Nearly, 74% of the jaundiced patients were between 20 and 29 years. About 92.1% of women belonged to class 4 and 5. The maximum percentage of (54.9%) jaundiced women were primigravida. Most women (80.39%) were presented with jaundice during the third trimester. Predominant symptoms were discoloration of skin present in all, and nausea and vomiting in 70.6% of women. At least 95% of women were ignorant about drinking water hygiene and use of safe water.
Viral hepatitis was the commonest etiology in 50.98% of women in the study. HELLP syndrome, a life-threatening pregnancy complication, was diagnosed as a cause of jaundice in 30.72%. Acute fatty liver of pregnancy was causative for 50% of deaths. HELLP syndrome was fatal in one unbooked pregnant woman. Preterm births were seen in 46% of women. Perinatal mortality was 33% and of these 30% was due to prematurity. AFLP and chronic liver disease with portal hypertension were the cause in 7.84%. Maternal mortality among pregnant women with jaundice was a significantly high 7.8%,
and accounted for 12.5% of total maternal deaths (P < 0. 0000001).

Conclusion Although liver diseases are seen infrequently in pregnancy, the complications associated with liver dysfunction can result in severe maternal and fetal compromise. Obstetricians must remain vigilant to detect early compromise in liver function to save mother and baby. Health workers should be trained in screening and early referral. Safe drinking water should be provided for all. Improved sanitary precautions should be taught during antenatal visits and hazards of promiscuity with relation to hepatitis B and other infections should be explained to the public. Screening for hepatitis B should be done during the first visit, especially in high-risk areas for liver infections. Detection of infections such as hepatitis E, and leptospirosis in pregnant women is life saving for mother and baby if done early. The call is for early booking of pregnant women to prevent maternal and perinatal morbidity and mortality. Appropriate management of preeclampsia by early diagnosis and referral for high-risk pregnancies.