Study of feto-maternal outcome in patients with hepatitis E infection during pregnancy
Keywords:Hepatitis E, Hepatic failure, DIC, Pregnancy
Background: Hepatitis E is considered as a common cause of high maternal morbidity and mortality particularly in third trimester and also high perinatal morbidity and mortality. Thus, this study is conducted to evaluate the feto-maternal outcome in patients infected with hepatitis E during pregnancy.
Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at L. G. hospital. Fifty pregnant women with clinical hepatitis in third trimester of pregnancy were included in this study and thorough investigation were carried out. Patients were monitored till postpartum period and fetal monitoring data were collected from neonatal ICU.
Results: In this study, majority of pregnant patients with hepatitis B were admitted during monsoon season suggests that HEV outbreaks are more common during monsoon months. Majority of the patients (70%) were emergency cases. Majority of these patients (82%) were belonged to lower socio-economic class. Co-infection with HAV was in 2% and with HBV in 4%. S. bilirubin >15 mg/dl in 16% of patients. PT and APTT were raised in 28% of patients. FDP was raised in 70% of patients. 76% were delivered vaginally and 22% were delivered by LSCS. Most common complication in HEV infected pregnant women was disseminated intravascular coagulation (DIC) (26%). Maternal mortality rate is 14%. Out of 50 patients, 88% delivered live baby, out of which 72% needed NICU admission. Perinatal mortality rate was as high as 28%.
Conclusions: Hepatitis E infection and pregnancy is a deadly and fatal combination. Specifically, in 3rd trimester of pregnancy, acute hepatitis E has a grave prognosis with high maternal morbidity and mortality. Prevention is the mainstay of controlling HEV especially in developing countries.
World Health Organization. Fact sheet: Hepatitis E, 2021. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitisn-e. Accessed on 10, September 2021.
Center for disease control and prevention. Hepatitis E, 2020. Available at: https://www.cdc.gov/ hepatitis/hev/hevfaq.htm. Accessed on 20, December 2020.
Sookoian S. Liver disease during pregnancy. Acute viral hepatitis. Ann hepatol. 2006;5(3):231-6.
Adam RH, Combes R. Viral hepatitis during pregnancy. JAMA. 1965;192(3):195-8
Saeedi MI, Mahmood K, Amanullah, Ziauddin M. Frequency and clinical course of hepatitis E in tertiary care hospital. J Coll Physicians Surg Pak. 2004;14(9):527-9.
Rachana K, Sayenna U, Sarosh R, Jose K. Seroprevalence and mother-to-infant transmission of hepatitis E virus in the United Arab Emirates. Eur J Obstetr Gynecol Reprod Biol. 2001;100(1):9-15.
Shinde NR, Patil T, Deshpande A, Gulhane R. Clinical profile, maternal and fetal outcomes of acute hepatitis E in pregnancy. Ann Med Health Sci Res. 2014;4(2):S133-9.
Nira S, Sanjaya S, Asha S, Kasturi M. Maternal and Perinatal outcome of pregnancy with hepatitis e infection. J s Asian federation obstetr gynecol. 2011;3(1):17-20.
Prasad GS, Prasad S, Bhupali A, Patil AN. A Study of Hepatitis E in Pregnancy: Maternal and Fetal Outcome. J Obstet Gynaecol India. 2016;66(1):18-23.
Kumar N, Das V, Agrawal S, Pandey A. Fetomaternal outcomes in pregnant women with hepatitis E infection; still an important fetomaternal killer with an unresolved mystery of increased virulence in pregnancy. Turk J Obstet Gynecol. 2017;14(2):106-13.
Javed N, Ullah SH, Hussain N, Sheikh MA, Khan A. Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes. East Mediterr Health J. 2017;23(8):559-63.