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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
 ~  References

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BRIEF COMMUNICATION
Year : 2003  |  Volume : 21  |  Issue : 3  |  Page : 184-185
 

Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: A prospective study from north india


Departments of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi - 110 002, India

Correspondence Address:
Departments of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi - 110 002, India

 ~ Abstract 

The present study aimed to find out the prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy in North India. The study was conducted on 97 consecutive pregnant patients in third trimester with acute viral hepatitis (AVH) or fulminant hepatic failure (FHF). The patients were evaluated on the basis of history, examination, liver function profile and serological markers for hepatitis A,B,C and E viruses. Hepatitis E virus (HEV) was the causative agent in 47.4% of the cases of viral hepatitis and 52.6% were caused by non-E viruses(HAV-5.2%,HBV-7.2%,HCV-0%,non A-E 47.4%). HEV was responsible for 36.2% of the cases of AVH and 75% of the cases of FHF. The mortality was 24.7% (24/97). All of them had FHF. Eighteen of 24 cases (75%) who expired were HEV positive. The mortality rate was 39.1% in HEV group and 11.7% in non HEV group. Majority of patients (87.5%) who expired had died undelivered. Hepatitis E was the commonest etiological agent in those who had fulminant disease during pregnancy and was associated with high mortality rate.

How to cite this article:
Beniwal M, Kumar A, Kar P, Jilani N, Sharma J B. Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: A prospective study from north india. Indian J Med Microbiol 2003;21:184-5


How to cite this URL:
Beniwal M, Kumar A, Kar P, Jilani N, Sharma J B. Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: A prospective study from north india. Indian J Med Microbiol [serial online] 2003 [cited 2019 Sep 22];21:184-5. Available from: http://www.ijmm.org/text.asp?2003/21/3/184/8012


Acute viral hepatitis (AVH) is a systemic infection affecting the liver predominantly. It is caused by six distinct types of viruses A,B,C,D,E and G.[1] Acute viral hepatitis is defined as those cases which have acute self limited disease and a serum aspartate aminotransferase elevation of atleast five fold or clinical jaundice or both.[2] Fulminant hepatic failure is considered when the patient after having a typical acute hepatitis, develops hepatic encephalopathy within four weeks. It is characterized by mental changes progressing from confusion to stupor and coma as a result of severe impairment of hepatic function, without any history of pre-existing liver disease.[3]
Viral hepatitis in pregnancy has been a subject of continuing interest and controversy. Reports from Europe and United States have shown the course of viral hepatitis during pregnancy to be in no way different from non pregnant women.[4],[5] However, studies carried out in India, Iran, Africa and Middle East have found the incidence of fulminant hepatitis to be higher in pregnancy.[6],[7] Malnutrition superimposed on the normal demands of pregnancy and inversion of T and B lymphocytes in early pregnancy have been postulated to be the contributing factors.[8] The objective of the present study was to study the etiological spectrum and mortality among cases of viral hepatitis in the third trimester of pregnancy.

 ~ Materials and Methods Top

A prospective study was conducted on 97 pregnant patients in third trimester with AVH or FHF consecutively attending the department of Obstetrics and Gynaecology and Medicine from March 2000 to April 2002. A detailed history and thorough clinical examination was done. Liver function profile was done. The serum was analyzed for IgM anti HAV (ELISA), HBsAg (ELISA), IgM antiHBc (ELISA), anti HCV antibodies (ELISA), IgM anti HEV (ELISA) and HEV RNA (RT PCR). The patients were followed up for the progression of the disease and the mortality rates were analyzed.

 ~ Results Top

Of the 97 pregnant women in the third trimester 69(71.1%) presented as AVH and 28 (28.9%) presented as FHF. The spectrum with regard to etiological agent was HAV 5/97 (5.2%), HBV 7/97 (7.2%) ,HCV 0%, HEV 46/97 (47.4%) and non A-E 46/97 (47.4%). Co-infection was noted with HAV +HBV in 1/97(1.03%), HBV+HEV in 4/97 (4.1%) and HAV+HEV in 3/97 (3.1%) cases. Twenty five of 46 (54.3%) of HEV positive females presented with AVH whereas 21/46 (45.7%) presented with FHF. Seventy five percent cases of FHF were due to HEV infection.
Twenty four of 97 (24.7%) patients expired. All of them had FHF. Of these, 75% were HEV positive. The mortality rate among the HEV positive group was 18/46(39.1%) and 6/51 (11.7%) in non HEV group. Approximately 21% (5/24) of the expired patients belonged to the non A-E group whereas 4% (1/24) were HAV positive. Two HEV positive cases who expired had co-infection, one with HAV and other with HBV. Sixteen of 18 (88.9%) cases of HEV died undelivered whereas 5/6 (83.3%) cases in non HEV group died undelivered.

 ~ Discussion Top

HEV infection alone is responsible for 47.4% of the cases of viral hepatitis in pregnant females in the third trimester. This is corroborative with the fact that HEV infection accounts for 50-70% of all patients with sporadic viral hepatitis in India.[1] In pregnant females in third trimester with viral hepatitis, the prevalence of HEV infection is reoportedly between 40-57%.[9],[10] HAV infection was less common (0% vs 5.2%) and HBV infection more common (34.6% vs 7.2%) in central India.[9] HCV infection was not seen in any case as was also observed by other groups.[9] This is explained by the low prevalence of high risk factors for HCV transmission in the study group. Seventy five percent of the FHF cases were HEV positive. Thus, HEV was the most common hepatotrophic virus associated with FHF.[9],[10] Among the HEV positive pregnant females, the mortality rate was 39.1%. The mortality rate is in the range of 30-45%[9],[11] and may be as high as 70%.[10] Majority of the cases die undelivered.[10] Two of the five (40%) HAV positive patients expired out of which one had co-infection with HEV. One pregnant female who died had co-infection with HBV and HEV. Five of the 46 (10.8%) patients in non A-E group expired. Thus, HEV was associated with a high mortality rate among pregnant women. 

 ~ References Top

1.Aggarwal R, Krawczynski K. Hepatitis E: An overview and recent advances in clinical and laboratory research. J Gastroenterol Hepatol 2000;15:9-20.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Smedile A, Carcil, Verme G. Influence of delta infection on severity of hepatitis B. Lancet 1982;2:945-947.   Back to cited text no. 2    
3.Trey C, Davidson LS. The management of FHF In: Progress in liver disease. Popper H, Schafnner, Eds (Grune & Stration, NY) 1970:282-98.   Back to cited text no. 3    
4.Adams RH, Combes R. Viral Hepatitis during pregnancy. JAMA 1965;192:195-198.   Back to cited text no. 4    
5.Cahill KM. Hepatitis in pregnancy. Surg Gynaecol Obstet 1962;114:545-552.  Back to cited text no. 5    
6.Kamat SK. Prognosis of infective hepatitis in pregnant women In: Hepatitis. Vakil BJ, Shah SG, Eds. (Adoni Printers & Publishers, Bombay). 1975:50-53.  Back to cited text no. 6    
7.Borhanmanesh F, Haghighi P, Hekmat K, Rezaizadeh K, Ghavani AG. Viral hepatitis during pregnancy: Severity and effect on gestation. Gastroentrol 1973;64:304-312.  Back to cited text no. 7    
8.Strelkauskas AJ, Darties IJ, Dray S. Longitudnal studies showing alterations in the levels and functional response of T and B lymphocytes in human pregnancy. Clin Exp Immunol 1978;32:531-39.  Back to cited text no. 8    
9.Jaiswal SPB, Jain AK, Naik G, Soni N, Chitnis DS. Viral hepatitis during pregnancy. Int J Gynaec Obstet 2001;72:103-108.  Back to cited text no. 9    
10.Singh S, Mohanty A, Joshi YK, Dwivedi SN, Deka D. Outcome of hepatitis E virus infection in Indian pregnant women admitted to a tertiary care hospital. Indian J Med Res 2001;113:35-39.  Back to cited text no. 10    
11.Khuroo MS, Kamili S, Jameel S. Vertical transmision of hepatitis E virus. Lancet 1995;315:1025-1026.  Back to cited text no. 11    
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2004 - Indian Journal of Medical Microbiology
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