Fulminant hepatic failure during pregnancy.

Objective: To observe clinical characteristics, etiology and maternal outcome in fulminant hepatic failure during pregnancy. Study Design: Descriptive Case Series. Setting: Department of Medicine, Nishtar Hospital Multan. Period: January 2013 to December 2017. Material & Methods: Twenty nine consecutive patients with fulminant hepatic failure during pregnancy were included in the study. Results: Mean age of patients was 27.06±6.92 years. 65.51% patients were from urban areas. Mean duration of gestation was 24.80±6.03 weeks. Jaundice and altered consciousness were observed in 100% cases, pallor in 79.31%, hepatomegaly in 20.68%, flapping tremors in 10.34%, ascites in 10.34% and splenomegaly in 6.89% cases. Complications observed were cerebral edema in 44.82%, renal failure in 24.13%, bleeding in 20.68% and hypoglycemia in 3.44%. Most common cause was acute hepatitis E (75.86%) followed by hepatitis B (13.79%) and hepatitis A (3.44%). No cause was found in 6.89% cases. Overall maternal mortality was 37.93% and fetal mortality was 72.41%. In 17.24% cases pregnancy was terminated therapeutically, 44.82% cases had spontaneous expulsion and in 37.93 % cases pregnancy continued. Maternal mortality was highest (45.45%) in patients who remained pregnant as compared to 20% when pregnancy was terminated therapeutically. Conclusion: Jaundice and altered conscious level is the most common clinical presentation. Hepatitis E is the most common cause of FHF in pregnancy. Maternal mortality in FHF during pregnancy is very high.

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Hepatitis E associated fulminant hepatic failure and its outcome in pregnancy.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.10.4218 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2165-2169

Author(s):

Zahida Parveen Brohi ◽

Uzma Parveen ◽

Aneela Sadaf

Keyword(s):

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

First Trimester ◽

Hepatitis E ◽

University Hospital ◽

Fetal Mortality ◽

Clinical Issue ◽

Viral Marker ◽

Study Results ◽

In Pregnancy

Objectives: To determine the clinical features and outcome of hepatitis E associated fulminant hepatic failure in pregnancy. Study Design: Observational Retrospective study. Setting: Department of Obstetrics & Gynecology at Isra University Hospital Hyderabad. Period: Three years from 1st January 2015 to 31st December 2017. Material & Methods: Total 3596 obstetric patients were admitted whom 168 pregnant women who were positive for hepatitis E viral marker have been included in the study. Results: Their age was between 18 to 47 years with mean age 26.04±6.40 years; majority of patients had not received antenatal care 123 (73.2%). Out of 168, 27 (16%) presented in the first trimester, 45 (26.7%) presented in the second trimester, while 96 (57.1%) patients developed fulminant hepatic failure in their 3rd trimester of pregnancy. Out of 168, 111(66%) patients delivered and 57 (33.9%) were undelivered. Fetal and perinatal outcome of delivered patients showed miscarriage 45 (40.5%), stillborn 25(14.8%), preterm delivery 17(15.3%), neonatal death 7 (6.3%) and 17 (15.3%) new born remained alive. Overall maternal mortality was 51 (30.3%). Conclusion: Hepatitis – E related fulminant hepatic failure in pregnancy is a troublesome clinical issue and connected with exceptionally high maternal and fetal mortality. Appropriate diagnosis, early timely intervention can considerably diminish the morbidity and mortality associated with (HEV) Fulminant hepatic failure.

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