Ranjan Asha, Thakur Surinder, Mokta Jatinder, Bhawani Rajesh, Ranjan Varsha
Senior Resident.
Professor.
J Assoc Physicians India. 2017 Dec;65(12):44-48.
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.
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.
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).
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.
近期在喜马偕尔邦西姆拉爆发的戊型肝炎疫情导致了显著的发病率和死亡率，尤其是在孕妇中。急性肝衰竭（ALF）患者的总体死亡率为0.5%-4%，而孕妇的死亡率明显更高（20%）。本研究旨在观察孕妇的临床特征和结局。
这是一项回顾性观察研究，对3个月期间收治的急性戊型肝炎孕妇和产后患者进行。病史重点关注症状、持续时间、发病、进展、合并症、妊娠结局、注意到的并发症。使用戊型肝炎IgM ELISA进行戊型肝炎感染的确认。
共观察了26例患者，其中8例为孕妇，18例为产后患者。平均就诊年龄为26.11±3.7岁，平均住院时间为10.46天。8例（30.76%）患者需要重症监护。就诊主诉与病毒性肝炎的典型表现相似。所有患者就诊时均有黄疸，8例（30.76%）患者有肝性脑病（HE），8例（30.76%）患者有急性肝衰竭（ALF），20例（76.92%）有败血症，7例（26.92%）发生早产。在总共14例分娩的患者中，5例出现不良胎儿结局，在此期间有5例死亡（15.38%）。导致住院死亡的因素为就诊时精神状态改变（p0.018）、水肿（p 0.046）、HE（0.018）、急性肝衰竭（0.018）。
戊型肝炎感染在孕妇中的发病率和死亡率更高，胎儿结局不良。死亡率很高（15.38%）。就诊时精神状态改变、水肿、HE、ALF与死亡率有显著相关性（<0.05）。
