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  • Title: Clinical Profile and Outcome of Pregnant Patients with Acute HEV Hepatitis During Water Borne Epidemic in Himachal Pradesh: A Hospital Based Study.
    Author: Ranjan A, Thakur S, Mokta J, Bhawani R, Ranjan V.
    Journal: J Assoc Physicians India; 2017 Dec; 65(12):44-48. PubMed ID: 29327522.
    Abstract:
    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.
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