Viral hepatitis in pregnancy

Abstract

Fifty pregnant women with viral hepatitis were compared with 31 non-pregnant women with viral hepatitis in a prospective case-control study. The two groups were matching except for the serum bilirubin level and area of residence. Seven pregnant women died while none of the control patients died and the difference between the two groups was significant. More than 80% of the deaths occurred in the third trimester and most of them were post-partum deaths. Except for a higher incidence of pre-term birth, the outcome of pregnancy in the case group was not affected. It is concluded that pregnancy is a risk factor which increases the mortality of viral hepatitis and that viral hepatitis does not affect the outcome of pregnancy except for pre-term birth.

PIP: 50 pregnant women and 31 nonpregnant women (age 15-40 years) with viral hepatitis admitted to Wad Medani Teaching Hospital, Sudan, during the period January 1987-January 1990 were compared in a prospective case control study. The mean serum bilirubin level was higher in the control group and the difference was statistically significant (p = 0.0084). Significantly more case came from rural settings (76%) compared with control patients (48%) (p 0.01). The criteria for admission were the presence of symptoms and signs of hepatitis and bilirubin in the urine. Almost all patients admitted to the study had viral hepatitis caused by type A virus, type B virus, or non-A, non-B viruses, however, a very small number of diseases of patients could be attributed to rare viruses like EB or cytomegalovirus. No specific medication was given and patients were managed by bed rest and parenteral multivitamins (Parentrovit). All patients were kept in the hospital until they became asymptomatic and serum bilirubin dropped to less than 2 mg/100 ml. All cases and controls were followed up for 6 weeks. All the control patients were discharged after recovery and none of them died or developed recurrence of disease. Out of the 50 pregnant women, 7 died, giving a maternal mortality rate of 14%; the rest recovered and none of them developed recurrence of disease during the follow-up period. The difference between the 2 groups was statistically significant (p = 0.04). The estimated relative risk of death in viral hepatitis with pregnancy was 9.93. Among 5 deaths that occurred after delivery during the 3rd trimester 1 was at term and the baby was normal; 4 were preterm deliveries. Out of the 50 pregnant women, 1 died before delivery and 1 delivered at home. The outcome of pregnancy in the remaining 48 was: 2 abortions (4.2%), 10 preterm (20.8%), and 36 (75%) term deliveries. There were 2 stillbirths (4.2%) one at term and one at 34 weeks.