Fetomaternal outcomes in pregnant women with hepatitis E infection; still an important fetomaternal killer with an unresolved mystery of increased virulence in pregnancy

Abstract

Objective:Hepatitis is a prevalent infection in developing countries. While hepatitis B and C are deepening their roots in the developed world, hepatitis A and E are common in the developing world. The uniqueness of hepatitis is in its transformation from a relatively self-limiting disease in the non-pregnant state, to a highly virulent disease during pregnancy.Materials and Methods:This retrospective observational study was conducted in the Department of Obstetrics and Gynecology, King George’s Medical University, Lucknow, for a period of six months from June 2016 to November 2016 [probably during an endemic peak of hepatitis E virus (HEV)] to observe the clinical outcomes in HEV-infected pregnant women.Results:A total of 32 anti-HEV immunoglobulin M-positive pregnant women were included, and fetomaternal outcomes were analyzed. Hepatitis E positivity was significantly associated with maternal mortality, intrauterine demise with prematurity, and premature rupture of membranes was the most common fetal complication noted.Conclusion:The difference in extent of virulence of infection and variations in maternal morbidity, mortality, and rates of intrauterine demise, signify the presence of some factors that play a role and need to be further studied and evaluated.

Pregnancy outcome with hepatitis E infection

“…In this study total 120 patients with hepatitis E were studied out of which nearly half of the patients had abnormal coagulation. This result is slightly higher than the result obtained from Kumar et al in which 31.2% had abnormal coagulation; however, it is lower than the study published by Patra et al in which 79% of cases had coagulopathies due to Hepatitis E. 7,8 The results of this present study are consistent with the studies published by Mishra et al and Badrakiya et al in which the percentage of patients with abnormal coagulation were 54.29% and 60% respectively. 9,11 Percentage of patients complicated with hepatic encephalopathy in this study was 28.3% which is found to be slightly higher to the studies published by Mishra et al, Kumar et al, and Badrakiya et al with their respective results as 20.95%, 21.8% and 15.4%.…”

“…Similar results have been seen in a study conducted by Kumar et al at King George Medical College, Lucknow wherein 90.63% patients delivered vaginally and 9.37% underwent lower segment caesarean section. 8 Also in the study by Badrakiya et al, 82% of pregnant patients with Hepatitis E had vaginal delivery while the percentage of caesarean section was 15.4%. 11 The inference from this analysis is that patients with hepatitis E go more often into spontaneous labour and deliver vaginally and less operative intervention is required.…”

“…The incidence calculated in the present study is 3.09 per 1000 deliveries which are similar to the incidence in the study by Patra et al which is 3.95 per 1000 deliveries and lower than Kumar et al which are 8.6 per 1000 deliveries. 7,8…”

Hepatitis E during pregnancy: Maternal and foetal case‐fatality rates and adverse outcomes—A systematic review

“…Screening forms for title and abstract screening, and full‐text screening were developed, piloted, and the screening questioned were adapted after piloting, before applied to the uploaded references. After screening of titles, abstracts and full texts, 21 references remained . Two additional studies were identified by checking references of included relevant papers .…”

“…The mean sample size was 58 (range 10‐148) with a total number of 1338 cases. Twelve studies had confirmed HEV diagnosis as an inclusion criteria, the rest had either jaundice, acute viral hepatitis or fulminant hepatic failure (FHF) as an inclusion criteria and tested for HEV later in the study. Most of the studies (20/23) had a follow‐up period that included delivery.…”