Clinical Profile, Maternal and Fetal Outcomes of
Acute Hepatitis E in Pregnancy

Shinde NR; Patil TB; Deshp; e AS; Gulhane RV; Patil MB; Bansod YV

Clinical Profile, Maternal and Fetal Outcomes of Acute Hepatitis E in Pregnancy

Author(s):

Shinde NR, Patil TB*, Deshpande AS, Gulhane RV, Patil MB and Bansod YV

Background: Pregnant women are at increased risk of complications in hepatitis E virus (HEV) infection, with the risk increasing as the pregnancy progresses, often leading to fulminant hepatic failure and adverse fetal outcome. Aims: The primary objective of the following study is to evaluate the maternal and fetal complications of this infection and secondary aim is to compare the clinical features of hepatitis E in pregnant women to those in nonâ�?�?�?�?pregnant women. Subjects and Methods: This was a hospital based caseâ�?�?�?�?controls study, carried out from July 2008 to June 2010. Over a period of 2 years, cases were serologically confirmed pregnant women with hepatitis E, selected by screening in antenatal clinic. Controls were serologically confirmed nonâ�?�?�?�?pregnant women with hepatitis E, selected by screening in Medicine Outpatient Department. We studied 96 women with HEV infection, of which 52 were pregnant and 44 were nonâ�?�?�?�?pregnant. Clinical and laboratory profile of patients in both groups were studied. Patients were treated as per protocol and the outcome was studied in both groups. Pregnant women were followedâ�?�?�?�?up for fetal and maternal outcome. We used tâ�?�?�?�?test and zâ�?�?�?�?test to compare normally distributed data and nonâ�?�?�?�?normally distributed data, respectively. Chiâ�?�?�?�?square test was used to compare discrete values between groups. Results:Mean (standard deviation [SD]) age in pregnant patients was 24.1 (3.3) years while 32.6 (10.5) years in nonâ�?�?�?�?pregnant patients. 71.1% (37/52) of the patients were primigravida and 28.8% (15/52) patients were multigravida, by natural occurrence. Mean (SD) gestational age when infection occurred was 27.5 (7.2) weeks. Among pregnant women, 63.4% (33/52) were in 3rd trimester. Jaundice 1â�?�?�?�?5 days before presentation was seen in 51.9% (27/52) pregnant and 44.2% (23/44) nonâ�?�?�?�?pregnant women. Myalgia/arthralgia, fever, nausea/vomiting, right upper quadrant pain, jaundice, dark urine, lightâ�?�?�?�?colored stools, pruritus, diarrhea, altered sensorium and hematemesis/melena were presenting features. In pregnant group, 46.1% (24/52) patients developed encephalopathy while in nonâ�?�?�?�?pregnant group 34% (15/44) developed this complication. Among pregnant cases, 67.3% (35/52) survived and 32% (17/52) cases died. In nonâ�?�?�?�?pregnant group, nearly 90% (40/44) patients survived and only 9% (4/44) patients died. This difference was statistically significant (P < 0.01). Adverse fetal outcome was seen in 71.1% (37/52) pregnant women with acute hepatitis E, including preâ�?�?�?�?term delivery in 23% (12/52), stillbirth in 23% (12/52), abortion in 3.8% (2/52) and intraâ�?�?�?�?uterine fetal death in 21.1% (11/52) patients. Conclusions: There is significantly higher occurrence of hepatitis E infection in pregnant women than in nonâ�?�?�?�?pregnant women, which increases with gestation, with associated fulminant hepatic failure, maternal mortality and worse fetal outcome.

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