Outcome of pregnancy with severe liver disease.
OBJECTIVE
To study the incidence, presentation, and outcome of patients with severe liver disease in an urban Indian population.


METHODS
26 patients with severe liver disease were identified in the study period of one year at a teaching tertiary care institute in Mumbai. Investigations included bedside Bleeding and Clotting Time (BT/CT), coagulation profiles and liver and renal function tests. Management was directed towards initial stabilization followed by early delivery in an intensive care setting.


RESULTS
80.71% of the patients had HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. The remaining were cases of acute fulminant hepatitis and acute fatty liver of pregnancy. The most consistent finding was thrombocytopenia (88.46%). Disseminated Intravascular Coagulopathy (DIC) was the most common complication (65%). BT/CT were 100% sensitive for the diagnosis of DIC. Maternal and perinatal mortality were 42.3% and 61.5% respectively.


CONCLUSIONS
Intensive care facilities and an early diagnosis are essential for the management of mothers with severe liver disease. Prognosis is poor for patients with fulminant hepatitis and acute fatty liver. Screening for DIC is a must. Delay in recovery of biochemical parameters may indicate atypical disease. Patient education is essential at discharge.
Tank
P D
PD
Serth Gordhandas Sunderas Medical College and King Edward Memorial Hospital, Mumbai, India. drtank@bom3.vsnl.net.in
Nadanwar
Y S
YS
Mayadeo
N M
NM
D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D011256:Pregnancy Outcome; D014505:Urban Population / Q000706:statistics & numerical data