Materno-Fetal Outcomes with Viral Hepatitis in Pregnancy

Abstract

Objective To evaluate materno-fetal outcomes in pregnant women with jaundice. Methods A prospective study was conducted over a period of 6 months in a tertiary care hospital of Delhi, India. 82 pregnant women with jaundice were included. The serum was screened for viral markers, liver function tests, and coagulation status. Results The mean age of women was 27.3 ± 4.3 years. 43.9 % (n = 36) women were HEV positive, 36 % (n = 27) HBsAg positive, 4 % (n = 3) HAV positive and 1.3 % (n = 1) HCV positive. Intrahepatic cholestasis was diagnosed in 10.8 % (n = 8) of women. Maternal morbidity was evaluated in terms of chorioamnionitis (5.4 %, n = 3), encephalopathy (26.8 %, n = 15), and coagulopathy (67.9 %, n = 38). There were five maternal deaths, and all were unbooked with HEV-positive status and a bilirubin [15 mg/dl with deranged coagulogram and encephalopathy and IUDs. 79 women delivered vaginally, and three had cesarean section. Of the vaginal deliveries, 59.8 % (n = 49) went into spontaneous labor, and 25.5 % (n = 21) were induced for varied reasons (BPS \ 6/10 (38 %, n = 8)) and progressive derangement of LFT (38 %, n = 8). Among the 71 deliveries, 29 (40.8 %) were IUD and 42 (59.1 %) were live born. On analyzing the morbidity data, it was found that HEV-positive women (deranged coagulogram 71.05 %, IUD 75.86 %, encephalopathy 80 %) had a poorer outcome as compared to their HBsAg positive counterparts (deranged coagulogram 10.52 %, IUD 13.79 %, encephalopathy 6.66 %).

Obstetric and neonatal outcomes among pregnancies with hepatitis E infection

“…6 This high number of preterm deliveries is also in congruence with the study reported by Singla et al wherein the proportion of preterm deliveries was 76%. 3 The majority (54.1%) of the patients were primigravidae. This is comparable to the results reported by Sultana et al, wherein 40% of the patients were primigravidae.…”

“…This is in agreement with the approach followed by Singla et al, wherein also the rate of induction was small, at 25%. 3 Majority (63%) of the babies were in the range of birthweight 1 to 2.5kg; and average birth weight of neonate was 1.6kg. Perinatal mortality was 33%, which was accounted for by 5 fresh still births and 2 macerated still births.…”

Seroepidemiology of a recent outbreak of Hepatitis E in urban Shimla, Himachal Pradesh, India

“…These characteristics are similar to the first outbreak of HEV in Delhi. 24,25 This suggests that there is no change in the epidemiological pattern of hepatitis E outbreak observed in Shimla.…”

“…The mortality rates due to HEV in pregnancy vary from 0 to 13.88% in recent studies. 24,25 The Shimla hepatitis outbreak was predominantly hepatitis E outbreak. The characteristic features of the hepatitis E epidemic were (i) point source epidemic transmitted by fecally contaminated drinking water supply, (ii) involvement of a large population, (iii) high attack rate in young adults and (iv) high mortality in pregnant women with term pregnancies.…”

The expression patterns of immune response genes in the Peripheral Blood Mononuclear cells of pregnant women presenting with subclinical or clinical HEV infection are different and trimester-dependent: A whole transcriptome analysis

“…Early symptoms and clinical features among pregnant patients are similar to nonpregnant patients, however, there is a high risk of rapid progression to poor maternal, obstetric and foetal outcome. These include deranged coagulogram, encephalopathy, death, intra-uterine death and premature deliveries [15][16][17][18][19]. Understanding mechanism(s) of disease severity and mortality in pregnant women is of utmost importance and relevance for the endemic countries.…”