Patra Sharda, Kumar Ashish, Trivedi Shubha Sagar, Puri Manju, Sarin Shiv Kumar
G.B. Pant Hospital and Lady Hardinge Medical College, New Delhi, India.
Ann Intern Med. 2007 Jul 3;147(1):28-33. doi: 10.7326/0003-4819-147-1-200707030-00005.
Hepatitis E virus (HEV) infection is known to cause severe liver disease in pregnant women. It is unclear whether obstetric and fetal outcomes are worse in pregnant women with HEV infection than in women with other forms of viral hepatitis.
To compare maternal, obstetric, and fetal outcomes in pregnant women with acute viral hepatitis caused by HEV and other hepatitis viruses.
Observational cohort.
Tertiary care hospital, New Delhi, India.
220 consecutive pregnant women presenting with jaundice caused by acute viral hepatitis.
Maternal mortality and medical complications, obstetric complications, deliveries, and fetal outcomes.
Infection with HEV caused acute viral hepatitis in 60% of included women. Fulminant hepatic failure was more common (relative risk, 2.7 [95% CI, 1.7 to 4.2]; P = 0.001) and maternal mortality was greater (relative risk, 6.0 [CI, 2.7 to 13.3]; P < 0.001) in HEV-infected women than in non-HEV-infected women. Women with HEV infection were more likely than those with other forms of viral hepatitis to have obstetric complications (relative risk, 4.1 [CI, 1.7 to 10.2] for antepartum hemorrhage and 1.9 [CI, 1.3 to 2.7] for intrauterine fetal death; P < 0.001 for both) and poor fetal outcomes (relative risk, 1.2 [CI, 1.0 to 1.4] for preterm delivery [P = 0.005] and 1.8 [CI, 1.2 to 2.5] for stillbirth [P = 0.026]).
The findings may not apply to community settings, to women who are asymptomatic or have only minor symptoms, or in the setting of an HEV epidemic.
Pregnant women with jaundice and acute viral hepatitis caused by HEV infection had a higher maternal mortality rate and worse obstetric and fetal outcomes than did pregnant women with jaundice and acute viral hepatitis caused by other types of viral hepatitis.
已知戊型肝炎病毒（HEV）感染可导致孕妇发生严重肝病。目前尚不清楚HEV感染孕妇的产科和胎儿结局是否比其他形式病毒性肝炎的孕妇更差。
比较戊型肝炎病毒和其他肝炎病毒所致急性病毒性肝炎孕妇的孕产妇、产科和胎儿结局。
观察性队列研究。
印度新德里的三级护理医院。
220例因急性病毒性肝炎出现黄疸的连续孕妇。
孕产妇死亡率和医疗并发症、产科并发症、分娩情况及胎儿结局。
纳入的孕妇中，60%因HEV感染导致急性病毒性肝炎。与未感染HEV的孕妇相比，HEV感染的孕妇暴发性肝衰竭更为常见（相对危险度为2.7[95%可信区间为1.7至4.2]；P=0.001），孕产妇死亡率更高（相对危险度为6.0[可信区间为2.7至13.3]；P<0.001）。与其他形式病毒性肝炎的孕妇相比，HEV感染的孕妇更易发生产科并发症（产前出血的相对危险度为4.1[可信区间为1.7至10.2]，胎儿宫内死亡的相对危险度为1.9[可信区间为1.3至2.7]；两者P<0.001），胎儿结局也较差（早产的相对危险度为1.2[可信区间为1.0至1.4][P=0.005]，死产的相对危险度为1.8[可信区间为1.2至2.5][P=0.026]）。
这些发现可能不适用于社区环境、无症状或仅有轻微症状的女性，或戊型肝炎流行的环境。
与其他类型病毒性肝炎所致黄疸和急性病毒性肝炎的孕妇相比，戊型肝炎病毒感染所致黄疸和急性病毒性肝炎的孕妇孕产妇死亡率更高，产科和胎儿结局更差。
