ETIOLOGICAL SPECTRUM OF PREGNANCY-ASSOCIATED LIVER DISORDERS AND FETOMATERNAL OUTCOMES AT A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Objective: To determine the etiological spectrum of pregnancy-associated liver disorders and evaluate their associated fetomaternal outcomes at a tertiary care hospital in Pakistan.

Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Unit 9B, Jinnah Postgraduate Medical Centre, Karachi. A total of 103 pregnant women aged 18–45 years diagnosed with liver disorders during pregnancy were enrolled using a non-probability consecutive sampling technique. Demographic, obstetric, clinical, laboratory, and outcome data were collected using a structured proforma. Pregnancy-associated liver disorders included HELLP syndrome, obstetric cholestasis, acute fatty liver of pregnancy (AFLP), and viral hepatitis. Maternal outcomes included intensive care unit (ICU) admission, blood transfusion requirement, postpartum hemorrhage, disseminated intravascular coagulation, renal failure, hepatic encephalopathy, and maternal mortality. Fetal outcomes included preterm birth, low birth weight, fetal distress, neonatal intensive care unit (NICU) admission, and perinatal mortality. Data were analyzed using SPSS version 26.0.

Results: Obstetric cholestasis (48.5%) and HELLP syndrome (47.6%) were the predominant etiologies. Women with HELLP syndrome had significantly higher rates of ICU admission (28.6%), preterm birth (53.1%), low birth weight (44.9%), fetal distress (26.5%), and NICU admission (30.6%). Multivariable analysis identified HELLP syndrome, unbooked pregnancy, and gestational age below 34 weeks as independent predictors of adverse maternal outcomes, while HELLP syndrome and maternal ICU admission independently predicted adverse neonatal outcomes.

Conclusion: Pregnancy-associated liver disorders were associated with substantial fetomaternal morbidity, particularly among women with HELLP syndrome, highlighting the importance of early recognition and multidisciplinary management.