Acute viral hepatitis in pregnancy: A catastrophe

Abstract

Background and Aim: Acute viral hepatitis during pregnancy is associated with significant maternal and fetal morbidity, particularly in regions where Hepatitis E virus (HEV) is endemic. This study aimed to evaluate the etiological spectrum, clinical profile, maternal complications, and fetal outcomes of acute viral hepatitis in pregnant women, with special emphasis on HEV infection. Methods: This hospital-based observational study included 25 pregnant women diagnosed with acute viral hepatitis. Clinical features, laboratory parameters, trimester distribution, maternal complications, and fetal outcomes were analyzed. Patients were categorized into HEV and non-HEV groups for comparison. Results: HEV was the predominant etiology, accounting for 84% of cases, while 16% were due to HAV. Most patients were unbooked (90%), and 68% of HEV infections occurred in the third trimester. The mean serum bilirubin level was higher in the HEV group (12.58 mg/dL) compared to non-HEV cases (7.8 mg/dL), with significantly longer hospital stay (10.9 vs. 5 days; p<0.001). Maternal complications among HEV cases included fulminant hepatic failure (23.8%), disseminated intravascular coagulation (33%), hepatic encephalopathy (23.8%), and acute renal failure (9.52%). Maternal mortality was 28% in the HEV group, while no deaths occurred in the non-HEV group. Adverse fetal outcomes in HEV infection included intrauterine fetal demise (35.29%), preterm delivery (29%), and low birth weight (84.61%). Conclusion: HEV is the leading cause of acute viral hepatitis in pregnancy and is associated with severe maternal complications and poor fetal outcomes. Early diagnosis, close monitoring, and improved antenatal care are essential to reduce morbidity and mortality.