Clinical Profile and Outcome of Pregnant Patients with Acute HEV Hepatitis During Water Borne Epidemic in Himachal Pradesh: A Hospital Based Study.

BACKGROUND

Recent outbreak of HEV hepatitis epidemic in Himachal Pradesh in Shimla caused significant morbidity and mortality especially among pregnant patients. Overall mortality is 0.5- 4% in patients developing acute hepatic failure (ALF) and is significantly higher in pregnant patients (20%). Present study conducted to observe clinical profile and outcome in pregnant patients.

METHODOLOGY

this is a retrospective observational study done on admitted pregnant and post partum patients with acute HEV hepatitis during 3 months periods. History focussing on symptoms, duration, onset, progression, co morbidities, pregnancy outcome, complications noted. Confirmation of the HEV infection was done using HEV IgM ELISA.

RESULTS

Total 26 patients observed, among which 8 were pregnant and 18 were post partum Average age of presentation was 26.11±3.7 years and average duration of hospital stay 10.46 days. 8 (30.76%) patients required ICU care Presenting complaints were similar to typical presentation in viral hepatitis. All patients were icteric at presentation and 8 (30.76%) patients had hepatic encephalopathy (HE) and 8 (30.76%) patients had ALF, 20 (76.92%) sepsis and 7(26.92%) underwent preterm labour. Out of the total 14 patients who delivered, poor fetal outcome was seen in 5 patients died during this period (15.38%). Factors responsible for in hospital mortality were altered mental status at presentation (p0.018), edema (p 0.046), HE(0.018), acute liver failure(0.018).

CONCLUSION

HEV infection has more morbidity and mortality among pregnant females and poor fetal outcome. Mortality is high (15.38%). Altered mental status at presentation, edema, HE, ALF have significant correlation (<0.05) with the mortality.