title: Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile.
abstract: Coagulopathy is an important complication associated with hepatitis E virus (HEV) infection in pregnant women. Postpartum haemorrhage (PPH) remains a serious risk while managing the labour of these women. The aim of this paper is to study the factors influencing the occurrence of PPH in pregnant women with hepatitis E infection with coagulopathy. The labours of 38 pregnant women with hepatitis E and deranged coagulation profile were followed. Factors that may predict postpartum bleeding complications in women with HEV infection and deranged coagulation profile were statistically analysed. Of 38 pregnant women with acute viral hepatitis due to HEV, 13 (34%) suffered a PPH while 25 (66%) did not. On univariate analysis low alanine aminotransferase (P = 0.016), high international normalized ratio (P = 0.003), high levels of d-dimer (P = 0.008), presence of hepatic encephalopathy (P = 0.028), intrauterine fetal death (P = 0.001) and gastrointestinal bleeding (P = 0.004) were found to predict PPH. However, on multivariate analysis the only independent variable that predicted PPH was the presence gastrointestinal (GI) bleeding (odds ratio [OR] 11.363; 95% CI: 1.003, 125; P = 0.050). Women with GI bleeding have 11 times higher risk of PPH than those without a GI bleed; however, the confidence interval is very wide. Administration of fresh frozen plasma in the peripartum period reduces the risk of PPH. In conclusion, early recognition of factors which predict the risk of PPH and timely intervention with judicious use of blood and blood components in the peripartum period can improve the outcome of pregnant women with HEV infection with deranged coagulation.
authors: Department of Obstetrics and Gynecology.
authors: Manju
authors: M
authors: Puri
authors: Department of Obstetrics and Gynecology.
authors: Sharda
authors: S
authors: Patra
authors: Department of Obstetrics and Gynecology.
authors: Preeti
authors: P
authors: Singh
authors: Department of Obstetrics and Gynecology.
authors: Nidhi
authors: N
authors: Malhotra
authors: Department of Obstetrics and Gynecology.
authors: Shubha Sagar
authors: SS
authors: Trivedi
authors: Department of Hematology, Lady Hardinge Medical College.
authors: Sunita
authors: S
authors: Sharma
authors: Department of Gastroenterology, G B Pant Hospital , New Delhi , India.
authors: Ashish
authors: A
authors: Kumar
authors: Department of Gastroenterology, G B Pant Hospital , New Delhi , India.
authors: Shiv Kumar
authors: SK
authors: Sarin
keywords: coagulopathy; haemorrhage; hepatitis E; infection; maternal mortality; pregnancy