SPECTRUM AND OUTCOMES OF JAUNDICE IN PREGNANCY: EXPERIENCE FROM A TERTIARY CARE CENTRE OF ANDHRA PRADESH

Abstract

Background: Jaundice in pregnancy is an important high-risk condition in India, associated with significant maternal and perinatal morbidity and mortality. Routine screening for jaundice is an integral part of Antenatal Care (ANC), particularly during the third trimester when incidence is highest.

Objectives: To screen expectant mothers for jaundice during pregnancy and to evaluate the incidence, etiological factors, clinical profile, and maternal–fetal outcomes in an Indian tertiary care setting

Methods: This prospective screening study included 189 expectant mothers attending ANC and emergency obstetric services. All participants underwent clinical examination for jaundice, including inspection of sclera, skin, and palms. Laboratory evaluation comprised Liver Function Tests (serum bilirubin, SGOT, SGPT), with jaundice defined as serum bilirubin >2 mg/dl. Viral serology, including HBsAg testing, was performed as per national guidelines. Variables analyzed included gestational age, trimester of presentation, biochemical parameters, etiological diagnosis, and maternal and perinatal outcomes.

Results: Among the 189 screened expectant mothers, jaundice was identified in a small but clinically significant proportion, predominantly during the third trimester. Viral hepatitis emerged as the most common cause, accounting for the majority of cases, with Hepatitis E being a major contributor. Pregnancy-specific liver disorders such as HELLP syndrome, intrahepatic cholestasis of pregnancy, and acute fatty liver of pregnancy were also observed. Jaundice was associated with increased maternal complications and adverse perinatal outcomes, including preterm delivery and fetal loss, emphasizing its high-risk nature.

 Conclusion: In this prospective screening study of 189 expectant mothers, jaundice was identified in a clinically significant proportion, predominantly during the third trimester, reinforcing its classification as a high-risk obstetric condition. Viral hepatitis accounted for the majority of cases, consistent with Indian epidemiological trends, while pregnancy-specific liver disorders such as HELLP syndrome, intrahepatic cholestasis of pregnancy, and acute fatty liver of pregnancy constituted a substantial subset. Mothers with serum bilirubin levels exceeding 2 mg/dl demonstrated higher rates of maternal complications and adverse perinatal outcomes, including preterm delivery and fetal compromise. Early detection through routine antenatal screening, combined with prompt referral and multidisciplinary management, was associated with improved maternal stabilization and better fetal outcomes. Preventive strategies such as safe drinking water practices and Hepatitis B screening remain crucial. These findings support the inclusion of systematic jaundice screening as a standard component of antenatal care in India to reduce preventable maternal and perinatal morbidity and mortality.