A 26-year-old woman at 32 weeks of gestation presents with jaundice, vomiting, and lethargy over 5 days. ALT 2400 U/L, bilirubin 9 mg/dL, prothrombin time markedly prolonged, encephalopathy grade II. HBsAg negative, anti-HAV IgM negative, anti-HEV IgM positive. Which statement is correct?

• A Vertical transmission is the main determinant of maternal outcome
• B Ribavirin should be started immediately as it is safe in the third trimester
• C This infection characteristically resolves without risk of fulminant failure in pregnancy
• D Mortality in this setting can reach 15 to 25 percent, higher than in non-pregnant adults ✓

Explanation

Hepatitis E virus genotype 1, endemic in India, causes fulminant hepatic failure disproportionately in pregnant women, particularly in the third trimester, with reported maternal mortality of 15 to 25 percent versus under 1 percent in the general population. Ribavirin is teratogenic and contraindicated in pregnancy, so management is supportive with consideration of transplantation. Maternal outcome is driven by the severity of maternal hepatic failure, not vertical transmission.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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