Severe Hepatitis E During Pregnancy: Evaluating Early Delivery as a Safe and Effective Treatment Option
Submission: 21 May 2024 | Acceptance: 26 May 2024 | Publication: 24 June 2024
1 Dr. Sadaf Anwar Qureshi, Husnain Haider, Sughra Hussain, Zulqarnain Agha
1Assistant Professor, Department of Pathology, Ayub Medical College, Abbottabad
2PIMS, Islamabad
Corresponding: Dr. Sadaf Anwar Qureshi, Assistant Professor, Department of Pathology, Ayub Medical College, Abbottabad
Abstract
Background: There have been reports that around 70% of pregnant women who have acute hepatitis E quickly progress to acute liver failure with a short period of pre-encephalopathy. Acute liver failure presents with decreased synthesis of proteins from the liver causing coagulopathy, encephalopathy and other neurological complications.
Objective: Comparison of maternal and fetal outcomes in pregnant females with moderate and severe
hepatitis E infection
Materials and Methods: The approval from institutional review board of ethics was taken for this study. This prospective study was done in collaboration with Department of Gastroenterology and Department of Gynaecology, Fatima Memorial Hospital, Lahore for a period of 1year from 2020-2021. All pregnant females with serologically detected Hepatitis E.Pregnant females with deranged liver function tests with other causes than Hepatitis E Pregnancy related liver diseases.
Results: 87 patients were enrolled in the study. At the time of diagnosis, the patients in the first trimester were 7%, in the second trimester were 23% and in the third trimester were 57%. The patients below 30yrs of age were 77 patients (88.5%) while more than 30yrs old were 10 patients (11.5%). These patients were grouped according to severity of disease, which showed that 47 patients (54%) patients had severe liver disease due to hepatitis E as compared to 40 patients (46%) who had moderate disease. Majority of the patients with severe disease were in their third trimester of gestation.
Conclusion: Although there are no guidelines for management of pregnant patients with HEV infection, however if early delivery of the fetus is possible to prevent maternal mortality, it should be tried. Further randomized controlled studies are needed to decide the best way of managing these patients with HEV infection in pregnancy.
Keywords: Severe Hepatitis E, Pregnancy, Early Delivery, Safe and Effective, Treatment Option.