Audit of Liver Disorders in Pregnancy

Dr. Ishwari Raut, Dr Anupriya Maharshi

Abstract: Introduction: Liver disease during pregnancy presents a unique and complex medical challenge due to the physiological changes in liver function associated with gestation. Liver disease in pregnancy can be broadly categorized into those unique to pregnancy, such as intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy (AFLP) and those unrelated to pregnancy such as viral hepatitis or autoimmune liver disease. Maternal liver diseases significantly impact both maternal and fetal outcomes. The spectrum ranges from mild, self-limiting conditions to life threatening complications, including postpartum hemorrhage, maternal death, and fetal death. Timely diagnosis and interventions are of paramount importance to reducing morbidity and mortality rates. This audit explores the prevalence, clinical presentations, management and outcomes of liver disease in pregnancy. Materials and Methods: Type of study: Retrospective. Study area: MGM Medical College and Hospital, Aurangabad. Study period: January 2024 to February 2025 (14 months). Sample size: 22. Inclusion Criteria: All pregnant females with deranged liver function tests. Exclusion Criteria: Pregnant females with history of substance abuse. Results: In this study, 22 pregnant women diagnosed with liver disorders were evaluated. Most of them-about three out of four-had conditions that were specific to pregnancy, with HELLP syndrome being the most common. A few others were diagnosed with acute fatty liver of pregnancy (AFLP) and intrahepatic cholestasis of pregnancy (IHCP), while the remaining had general liver conditions like hepatitis or portal hypertension. Nearly all patients (95%) were referred from other centers, reflecting the specialized care available at our institute, particularly with access to multidisciplinary teams and a hepatobiliary unit. The majority of patients were young, between 18 and 25 years old. Many came in with symptoms such as nausea, vomiting, high blood pressure, and in some cases, signs like yellowing of the skin or intense itching-each pointing toward different underlying liver issues. Blood tests often revealed concerning findings like low platelet counts, abnormal liver enzymes, and impaired kidney function, especially in cases of HELLP, AFLP, and hepatitis. Preterm delivery was common, particularly in HELLP and hepatitis cases, and cesarean sections were more frequently performed in those with HELLP. Sadly, there were poor neonatal outcomes in several cases, including NICU admissions and five instances of stillbirth or intrauterine death. Maternal complications were also significant. Many women required ICU care, blood transfusions, and prolonged hospital stays. Some developed serious conditions like sepsis or acute kidney injury. Tragically, five mothers-two with AFLP and three with hepatitis-did not survive, underscoring how severe and life-threatening liver disorders can be during pregnancy. Conclusion: Liver disorders in pregnancy, particularly those unique to the gestational period such as HELLP syndrome, AFLP, and IHCP, pose significant risks to both maternal and fetal health. Early recognition and timely referral to specialized centers with multidisciplinary care capabilities are critical for optimizing outcomes. Despite advances in supportive and obstetric care, these conditions continue to carry high rates of maternal and neonatal morbidity and mortality. Our findings underscore the need for heightened clinical vigilance, rapid intervention, and the development of standardized protocols to manage liver-related complications during pregnancy more effectively.

Keywords: Deranged liver function tests, liver disorders in pregnancy, maternal mortality

How to Cite?: Dr. Ishwari Raut, Dr Anupriya Maharshi, "Audit of Liver Disorders in Pregnancy", Volume 14 Issue 5, May 2025, International Journal of Science and Research (IJSR), Pages: 1087-1090, https://www.ijsr.net/getabstract.php?paperid=MR25516141321, DOI: https://dx.doi.org/10.21275/MR25516141321