FULMINANT HEPATIC-FAILURE IN PREGNANT-WOMEN - ACUTE FATTY LIVER OR ACUTE VIRAL-HEPATITIS

Background: Hepatitis E virus, which is endemic in our region, can cau se severe liver dysfunction in pregnant women and this can be clinical ly confused with acute fatty liver of pregnancy. Methods: We studied t he clinical and laboratory data as well as the maternal and fetal outc omes of 12 pregnant women presenting with fulminant hepatic failure in order to determine the etiology of the disease. The clinical diagnose s were subsequently correlated with serologic assays for acute HEV inf ection, All patients were severely ill with deep jaundice, grade 3-4 e ncephalopathy and abnormal prothrombin times. Results: A clinical diag nosis of acute viral hepatitis was made in nine patients and of acute fatty liver in the other three cases, IgM and IgG antibodies confirmed acute viral hepatitis E in six of the nine patients while one had acu te hepatitis A infection, HEV IgM and IgG antibodies were, however, al so positive in two of the three patients thought to have acute fatty l iver, Maternal and fetal mortality were 16.6% and 50%, respectively. C onclusions: We conclude that hepatitis E is the usual cause of acute l iver failure in our pregnant women and that clinical and laboratory fe atures do not permit accurate distinction between acute HEV infection and acute fatty liver of pregnancy. The prognosis in patients with acu te HEV infection is much better than in other groups with severe liver failure (mortality 16% vs 68%).