Hepatitis E. in pregnancy

This prospective study was an attempt to determine the frequency of viral hepatitis in general, and hepatitis E virus (HEV) in particular, in 62 pregnant women who had jaundice in the third trimester. Maternal serum was analyzed for markers of hepatitis A, B, C, and E viruses, and cord blood samples were tested for immunoglobulin M anti-HEV antibody by enzyme-linked immunosorbent assay. HEV-RNA was identified by the reverse transcriptase polymerase chain reaction technique. HEV infection was diagnosed in 45% of the 62 women. Nine of these women developed fulminant hepatic failure (FHF), defined as deep jaundice and hepatic encephalopathy developing within 4 weeks. Most HEV-positive women were primigravidas and presented at 32 to 34 weeks gestation. The largest number of cases occurred in July. Both fever and deeply colored urine were common signs of HEV infection. Serum levels of bilirubin, aspartate aminotransferase, and alanine aminotransferase were higher in women with FHF. HEV accounted for 37% of cases of acute viral hepatitis and 81% of cases of FHF. More than one fourth of women with HEV infection had obstetric complications, including premature rupture of membranes, intrauterine growth restriction, placenta previa, and retained placenta. Approximately two thirds of women with HEV infection had preterm deliveries. Only 5% were not delivered vaginally. Mortality for HEV-positive women was 27%. Vertical transmission was documented in 33% of 18 cases of HEV infection. One third of pregnant women with HEV in this study had severe hepatitis in the third trimester. HEV infection during pregnancy is associated with a high risk of both preterm labor and mortality.