DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193520

An observational study of maternal and fetal outcome in pregnant women with Hepatitis E

Ranjana Mishra, Arun H. Nayak, Madhuri Mehendale

Abstract


Background: Hepatitis E in pregnancy has been a subject of interest in the recent years as the available research work is very limited and conflicting especially in pregnant women as compared to infection in men and non- pregnant women in which the disease is usually self- limiting. The mechanism of liver injury in hepatitis E is not clear and no conclusive theories about the exact pathogenesis are available. This study was done to gain insight into the effects of hepatitis E virus on pregnancy in terms of maternal and fetal outcome.

Methods: Total of 40 pregnant women with Hepatitis E Virus IgM antibodies was included in the study. Hepatitis cases due to other viral and non-infective causes were excluded. Maternal outcomes in terms of mode of delivery, complications like PPH, hepatic encephalopathy, fulminant hepatic failure, coagulopathy and maternal mortality was studied. Fetal outcomes in terms of intrauterine fetal deaths, stillbirth, live births, and neonatal deaths were studied.

Results: This study showed high mortality rates (42.5%) in pregnant women with hepatitis E. The most common obstetric complication was IUFD (45%) followed by preterm labor (32.5%) and postpartum hemorrhage (22.5%). Hepatic encephalopathy (62.5%) was the commonest medical complication followed by coagulopathy (25%). A statistically significant association was found between the presence of medical complications and poor maternal outcome.

Conclusions: Hepatitis E virus infection in pregnancy often has a fulminant course with poor maternal and fetal outcome. Its management therefore requires an early diagnosis, and a multidisciplinary approach.


Keywords


Hepatitis E Virus, Hepatic encephalopathy, IgM antibodies, Intrauterine fetal deaths, Maternal mortality, Postpartum hemorrhage

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References


Mellor AL, Sivakumar J, Chandler P. Prevention of T cell driven complement activation and inflammation by tryptophan catabolism during pregnancy. Nat Immunol. 2001;2:64.

Orsi NM, Gopichandran N, Ekbote UV, Walker JJ. Murine serum cytokines throughout the estrous cycle, pregnancy and post-partum period. Anim Reprod Sci. 2006;96:54-65.

Kasper L, Fauci J. Acute viral hepatitis. Harrison’s Princ Intern Med. 2015;2(18):2537-55.

Krawczynski K, Aggarwal R, Kamili S. Hepatitis E. Infect Dis Clin North Am. 2000;14:669-87.

Tsarev SA, Tsareva TS, Emerson SU. Infectivity titration of a prototype strain of Hepatitis E virus in cynomolgus monkeys. J Med Virol. 1994;43:135-42.

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

Yadav S. Maternal and fetal outcome in pregnancy with hepatitis E virus infection. Int J Reprod Contracept Obstet Gynecol. 2016;5(10):3482-90.

Naru T, Yousuf F, Malik A, Naz S, Ismail H. Comparison of foeto-maternal outcome in pregnant women with hepatitis E-A review of 12 years. J Pak Med Asso: JPMA. 2017;67(4):538.

Jethwa DK, Chauhan DV, Badrakiya GL, Badrakiya SG. Hepatitis E virus in pregnancy with fetomaternal outcome-A prospective study. IOSR. 2015;14(8):25-8.

Prasad GS, Prasad S, Bhupali A, Patil AN, Parashar K. A study of Hepatitis E in pregnancy: Maternal and fetal outcome. J Obstet Gynecol India. 2016;66(1):18-23.

Banait VS, Sandur V, Parikh F. Outcome of acute liver failure due to acute hepatitis E in pregnant women. Indian J Gastroenterol. 2007;26:6-10.

Khuroo MS, Kamili S, Yattoo GN. Severe fetal hepatitis E virus infection is the possible of increased severity of hepatitis E virus infection in the mother: another example of mirror syndrome. Indian J Gastroenteral. 2004;23(Suppl. 1):A1.

Pal R, Aggarwal R, Naik SR, Das V, Das S, Naik S. Immunological alterations in pregnant women with acute hepatitis E. J Gastroenterol Hepatol. 2005;20:1094-101.

Navaneethan U, Al Mohajer M, Shata MT. Hepatitis E and pregnancy: understanding the pathogenesis. Liver Int. 2008;28(9):1190-9.