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VOLUME 26 , ISSUE 1 ( January, 2022 ) > List of Articles

SYSTEMATIC REVIEW

Analysis of Causes of Hepatic Dysfunction in Obstetric Patients in India: A Systematic Review

Armin Ahmed, Afzal Azim

Keywords : Hepatic dysfunction, Obstetric patients, Preeclampsia, Viral hepatitis

Citation Information : Ahmed A, Azim A. Analysis of Causes of Hepatic Dysfunction in Obstetric Patients in India: A Systematic Review. Indian J Crit Care Med 2022; 26 (1):114-122.

DOI: 10.5005/jp-journals-10071-24083

License: CC BY-NC 4.0

Published Online: 17-01-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Epidemiology of liver disease in obstetric patients shows geographical variation depending upon the prevalence of preeclampsia, viral hepatitis, and tropical vector-borne diseases like malaria, leptospirosis, etc. We undertook the current systematic review to analyze the causes of hepatic dysfunction in obstetric patients in India and identify the gaps in the literature and reporting. Materials and methods: We did a systematic review of studies reporting the causes of hepatic dysfunction in obstetric patients in India. A methodological quality assessment was done using a five-point questionnaire. Results: A total of 21 studies qualified for evaluation. The rate of hepatic dysfunction among obstetric patients in India ranged from 0.15 to 3.3% with a mean and median rate of 1.49 and 0.93%, respectively. Preeclampsia/HELLP (mean = 36.0%, median = 31.4%, range: 3.6–83.8%) and viral hepatitis (mean = 34.1%, median = 35.5%, range: 5.1–61.8%) were the commonest causes of hepatic dysfunction. Other causes were intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, tropical fever (malaria, leptospirosis, dengue, scrub typhus), etc. Maternal mortality ranged from 1.4 to 40% (mean = 12.6%, median = 10.0%) and perinatal mortality was between 16.4 and 38.70% (mean = 31.75%, median = 35.5%). Conclusion: There is moderate quality evidence to show that preeclampsia/HELLP and viral hepatitis are the commonest causes of hepatic dysfunction in obstetric patients in India.


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  1. Strategies toward ending preventable maternal mortality (EPMM). 2015. Available from: https://www.who.int/reproductivehealth/topics/maternal_perinatal/epmm/en/.
  2. Maternal Mortality Rate (MMR). 2021. Available from: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1697441.
  3. Girum T, Wasie A. Correlates of maternal mortality in developing countries: an ecological study in 82 countries. Matern Health Neonatol Perinatol 2017;3:19. DOI: 10.1186/s40748-017-0059-8.
  4. Arora A, Kumar A, Anand AC, Puri P, Dhiman RK, Acharya SK, et al. Indian National Association for the Study of the Liver—Federation of Obstetric and Gynaecological Societies of India position statement on management of liver diseases in pregnancy. J Clin Exp Hepatol 2019;9(3):383–406. DOI: 10.1016/j.jceh.2019.02.007.
  5. Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol 2016;64(4):933–945. DOI: 10.1016/j.jhep.2015.11.030.
  6. Anand AC, Garg HK. Approach to clinical syndrome of jaundice and encephalopathy in tropics. J Clin Exp Hepatol 2015;5(Suppl. 1):S116–S130. DOI: 10.1016/j.jceh.2014.05.007.
  7. Deepak N A, Patel ND. Differential diagnosis of acute liver failure in India. Ann Hepatol 2006;5(3):150–156. PMID: 17060870.
  8. Devarbhavi H, Kremers WK, Dierkhising R, Padmanabhan L. Pregnancy-associated acute liver disease and acute viral hepatitis: differentiation, course, and outcome. J Hepatol 2008;49(6):930–935. DOI: 10.1016/j.jhep.2008.07.030.
  9. Denison HJ, Dodds RM, Ntani G, Cooper R, Cooper C, Sayer AA, et al. How to get started with a systematic review in epidemiology: an introductory guide for early career researchers. Arch Public Health 2013;71(1):1–8. DOI: 10.1186/0778-7367-71-21.
  10. Tiwari R, Kushwaha P, Meravi A. Analytical study to determine the impact of jaundice in pregnancy on maternal and perinatal outcome. Adv Hum Biol 2020;10(3):153–157. DOI: 10.4103/AIHB.AIHB_63_20.
  11. Changede P, Chavan N, Raj N, Gupta P. An observational study to evaluate the maternal and foetal outcomes in pregnancies complicated with jaundice. J Obstet Gynaecol India 2019;69(1):31–36. DOI: 10.1007/s13224-018-1105-9.
  12. Bhalla S, Bhatti SG, Kumar S, Kaur P. Predictors of feto-maternal outcome in pregnancies complicated by hepatic dysfunction: observational study in a tertiary care hospital in Punjab. Pan Asian J Obs Gyn 2019;2(1):12–21. Available from: https://journals.indexcopernicus.com/api/file/viewByFileId/674266.pdf.
  13. Padh JP, Shah Sr, Vyas RC, Parikh PM. A clinical study on fetomaternal outcome in jaundice with pregnancy. Int J Reprod Contracept Obstet Gynecol 2019;8(10):4079–4082. DOI: 10.18203/2320-1770.ijrcog20194384.
  14. Negi LM, Pathania K, Kumar D. Maternal and fetal outcome among pregnant women with jaundice attending a tertiary care institute in northern India. Int J Recent Sci Res 2019;10(4):31793–31796. DOI: 10.24327/IJRSR.
  15. Agrawal M, Bhanu M, Sankhwar P, Deo S, Jaiswar S. A study of spectrum and fetomaternal outcome of jaundice in pregnant women: an experience from a tertiary referral centre of North India. Int J Reprod Contracept Obstet Gynecol 2019;8(7):2838. DOI: 10.18203/2320-1770.ijrcog20193052.
  16. Devi KVSMS, Bhavani YVL. A comprehensive study on jaundice in pregnancy with emphasis on fetomaternal outcome. IAIM 2019;6(6): 18–22. Available from: https://iaimjournal.com/wp-content/uploads/2019/06/iaim_2019_0606_03.pdf
  17. Choudhary N, Sen S, Varalakshmi K. A prospective study on pregnancy complicated with jaundice with special emphasis on fetomaternal outcome. Int J Reprod Contracept Obstet Gynecol 2017;6(11):5081–5088. DOI: 10.18203/2320-1770.ijrcog20175029.
  18. Kohli UA, Seth A, Singh S, Mishra R. Liver ailments in pregnancy: our experience Int J Reprod Contracept Obstet Gynecol 2017;6(3):939–943. DOI: 10.18203/2320-1770.ijrcog20170560.
  19. Sunanda KM, Jois SK, Suresh S. A clinical study of the fetal outcome of jaundice in pregnancy in a tertiary care centre. Indian J Obstet Gynecol Res 2017;4(3):230–234. DOI: 10.18231/2394-2754.2017.0052.
  20. Suresh I, Vijaykumar TR, Nandeesh HP. Predictors of fetal and maternal outcome in the crucible of hepatic dysfunction during pregnancy. Gastroenterol Res 2017;10(1):21. DOI: 10.14740/gr787w.
  21. Tiwari A, Aditya V, Srivastava R, Gupta G. A study of spectrum and outcome of liver diseases in pregnant women at BRD medical college. Int J Reprod Contracept Obstet Gynecol 2017;6(8):3641–3645. DOI: 10.18203/2320-1770.ijrcog20173501.
  22. Solanke D, Rathi C, Pandey V, Patil M, Phadke A, Sawant P. Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: a prospective study from Western India. Indian J Gastroenterol 2016;35(6):450–458. DOI: 10.1007/s12664-016-0704-6.
  23. Sharma S, Aherwar R, Jawade S. Maternal and fetal outcome in jaundice complicating pregnancy: a prospective study. Int J Reprod Contracept Obstet Gynecol 2016;5(4):1084–1087. DOI: 10.18203/2320-1770.ijrcog20160862.
  24. Mitta P, Rao SV. Fetomaternal outcome in jaundice complicating pregnancy. J Dent Med Sci 2016;15(10):72–76. DOI: 10.9790/0853-1510067276.
  25. Krishnamoorthy J, Murugesan A. Jaundice during pregnancy: maternal and fetal outcome. Int J Reprod Contracept Obstet Gynecol 2016;5(8):2541–2545. DOI: 10.18203/2320-1770.ijrcog20162224.
  26. Mishra N, Mishra VN, Thakur P. Study of abnormal liver function test during pregnancy in a tertiary care hospital in Chhattisgarh. J Obstet Gynecol India 2016;66(Suppl. 1):129–135. DOI: 10.1007/s13224-015-0830-6.
  27. Satia MN, Jandhyala M. A study of fetomaternal outcomes in cases of jaundice at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2016;5(7):2352–2357. DOI: 10.18203/2320-1770.ijrcog20162126.
  28. Dsouza AS, Gupta G, Sandee SG, Katumalla FS, Goyal S. Maternal and fetal outcome in liver diseases of pregnancy–a tertiary hospital experience. Int J Sci Res Publ 2015;5(9):1–3. Available from: http://www.ijsrp.org/research-paper-0915.php?rp=P454608.
  29. Singh K, Kumar G, Singh A, Rani A. Outcome and management of antenatal patients with jaundice in tertiary care centre of eastern India: a retrospective study. Int J Res Med Sci 2015;3(9):2402–2404. DOI: 10.18203/2320-6012.ijrms20150638.
  30. Nath J, Bajpayi G, Sharma R. A clinical study on jaundice in pregnancy with special emphasis on fetomaternal outcome. J Dent Med Sci 2015;14(3):116–119. DOI: 10.9790/0853-1435116119.
  31. Ch'ng CL, Morgan M, Hainsworth I, Kingham JG. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002;51(6):876–880. DOI: 10.1136/gut.51.6.876.
  32. Duraiswamy S, Sheffield JS, Mcintire D, Leveno K, Mayo MJ. Updated etiology and significance of elevated bilirubin during pregnancy: changes parallel shift in demographics and vaccination status. Dig Dis Sci 2017;62(2):517–525. DOI: 10.1007/s10620-016-4282-3.
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