Sooner than later: a little effort may avert postpartum haemorrhage in patients with acute hepatitis E

Authors

  • Neha Thakur Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical College Raipur, Chhattisgarh, India
  • Ruchi Kishore Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical College Raipur, Chhattisgarh, India
  • Mitali Tuwani Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical College Raipur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20213648

Keywords:

Hepatitis E, Pregnancy, Postpartum hemorrhage, Condom balloon tamponade

Abstract

Background: The incidence of postpartum hemorrhage (PPH) in pregnancies with hepatitis E varies from 14-42%. Management of labor and PPH in these women with acute liver injury makes it a real obstetric challenge due to associated coagulopathies and contraindication for many drugs. Prophylactic insertion of condom balloon tamponade along with active management of the third stage of labour (AMTSL) prevent primary PPH in these women. Simultaneous use of injection tranexemic acid further gives reliable results. The present study was conducted to study the effectiveness of condom balloon tamponade in preventing PPH in pregnant women with acute hepatitis E in labor.

Methods: The present study was conducted in the Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical (JNM) College and associated Dr. Bhim Rao Ambedkar Memorial (BRAM) Hospital, Raipur, Chhattisgarh over period of two year from September 2018 to September 2020.

Results: During the study period 32 women presented with hepatitis E in labor. Condom balloon tamponade was inserted prophylactically in all hepatitis E virus (HEV) positive cases immediately after delivery of placenta along with vaginal packing, irrespective of amount of bleeding. Inspite of so many odds in the form of unscanned pregnancies, multiparity, multifetal gestation, abruption, intrauterine fetal death (IUFD), prolonged labor, deranged liver and coagulation profiles, anemia and thrombocytopenia, our study showed high effectiveness of prophylactic condom balloon tamponade by encountering only one case of PPH.

Conclusions: Prophylactic condom balloon tamponade insertion just after the removal of placenta is promising in averting PPH.

References

Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 17 and 2 in 2005. Hepatology. 2012;55(4):988-97.

Nimgaonkar I, Ding Q, Schwartz RE, Ploss A. Hepatitis E virus: advances and challenges. Nat Rev Gastroenterol Hepatol. 2018;15:96-110.

World Health Organization. Hepatitis E. Available at: https://www.who.int/en/news-room/factsheets/detail/hepatitis-e. Accessed on 08 July 2019.

Goumba CM, Yandoko-Nakouné ER, Komas NP. A fatal case of acute hepatitis E among pregnant women, Central African Republic. BMC Res Notes. 2010;3:103.

Fiore S, Savasi V. Treatment of viral hepatitis in pregnancy. Expert Opin Pharmacother. 2009;10(17):2801-9.

Siddiqui M, Rashid M. Balloon Tamponade to prevent primary PPH in Jaundice- A Prospective Study. J Bangl Coll Physic Surg. 2008;26(1):22-5.

Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute 35 hepatitis E virus infection. Ann Intern Med. 2007;147(1):28-33.

Yadav S, Shirodker S, Kshirsagar S. Maternal and fetal outcome in pregnancy with hepatitis E virus infection. Int J Reprod Contracept Obstet Gynecol. 2016;5:3482-90.

Shinde N, Patil T, Deshpande A, Gulhane R, Patil M, Bansod Y. Clinical profile, maternal and fetal outcomes of 42 acute hepatitis e in pregnancy. Ann Med Health Sci Res. 2014;4(2):133.

Prasad GS, Prasad S, Bhupali A, Patil AN, Parashar K. A Study of Hepatitis E in Pregnancy: Maternal and Fetal Outcome. J Obstet Gynaecol India. 2016;66(1):18-23.

Puri M, Patra S, Singh P, Malhotra N, Trivedi SS, Sharma S, Kumar A, Sarin SK. Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile. Obstet Med. 2011;4(3):108-12.

Shrestha P, Bhandari D, Sharma D, Bhandari BP. A study of viral hepatitis during pregnancy in Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2009;11:192-4.

Sultana R, Humayun S. Fetomaternal outcome in acute hepatitis e. J Coll Physicians Surg Pak. 2014;24(2):127-30.

Khuroo MS, Kamili S, Jameel S. Vertical transmission of hepatitis E virus. Lancet. 1995;345:1025-6.

Downloads

Published

2021-09-27

Issue

Section

Original Research Articles