Aetiology of Acute Hepatitis in Bangladeshi Pregnant Women in the Third Trimester: Experience from a Tertiary Hospital in Bangladesh

Abstract

Introduction: Acute hepatitis in pregnancy in not uncommon in Bangladesh. There has been a rise in acute viral E hepatitis in Bangladesh after the 2004 floods. At that time most of the country was under water for more than a month leading to sewerage contamination of water supply. The aim of this study was to see the aetiology of acute hepatitis in pregnant women in the third trimester in Bangladesh. Materials and Methods: In this retrospective study, 31 pregnant women in their third trimester with acute hepatitis were included. Only those patients who presented with prodromal features like icterus, nausea and vomiting, fever and raised serum bilirubin and raised serum transaminase levels were included in this study. They were all previously healthy and came to the Unit from all over Bangladesh. Patients were tested for markers for common hepatotrophic viruses. Relevant history was taken. Patient Record Book of the Unit was reviewed and patients who fulfilled the criteria were included in this retrospective study. Results: 45.16% (14/31) had HEV infection. They were all anti-HEV IgM positive by ELISA. HBV infection was detected in 6.45% (2/31). All these later patients tested positive for either HBsAg or anti-HBs IgM by ELISA. Both anti-HEV IgM and HBsAg were positive in 9.38% (3/31) patients. No viral marker could be detected in 38.7% (12/31) patients. Overall 54.84% (17/31) patients had HEV and 16.12% (5/31) had HBV infection. No patient had history of drug or alcohol intake. Conclusion: Acute viral E hepatitis is the leading cause of acute hepatitis in pregnancy in Bangladesh. Sewerage contamination of water supply following flood contributed to the higher incidence of HEV infections. Hepatitis B virus infection is also important.