Predictors of poor maternal outcome in pregnant women with acute viral hepatitis

Background: Acute viral hepatitis is the most common cause of jaundice in pregnancy. Various criteria have been devised to determine early indices of poor prognosis in patients with fulminant hepatic failure (FHF) but no such criteria exist for pregnancy related liver failure. Aim: To determine the predictors of poor maternal outcome in pregnant women with acute viral hepatitis. Methodology: This prospective observational study was conducted in Lady Hardinge Medical College, New Delhi from January 2009 to April 2010. In present study, 50 pregnant women with acute viral hepatitis with or without FHF were included and closely followed with daily clinical assessment and subjected to serial investigations. Results: In our study, amongst the 50 pregnant women, 40 were survivors and 10 were non survivors. 94% of the patients were infected with hepatitis E. All patients (100%) had jaundice. There was a statistically significant difference between the mean TNF α in patients with acute viral hepatitis without fulminant hepatic failure (FHF) (59.80 ± 65.95 pg / ml) and in patients with acute viral hepatitis with FHF (322 ± 231.2 pg / ml ) which was raised. 80% of the non survivors had coagulopathy (d-dimers >16 µg/ml) as compared to 10% of the survivors. Conclusions: In this study we have ascertained few poor prognostic factors for maternal outcome in acute viral hepatitis in pregnancy. Further studies need to be done among pregnant women with acute viral hepatitis with larger study population in order to develop criteria for selection and timely referral of pregnant women with FHF for orthotopic liver transplantation to improve maternal survival.