Question

What is the most likely cause for a 26 year old pregnant woman from Bihar referred to a tertiary centre with hepatic encephalopathy?

• A. HAV
• B. HBV
• C. HCV
• D. HEV

Hint:

Think about which hepatitis virus is notorious for causing liver failure specifically in pregnant women.

Answer 1

The Correct Option is D

Step 1: Recall why pregnancy and viral hepatitis matter together.
Most cases of viral hepatitis are mild and self limited, but one type is well known for turning severe and causing acute liver failure specifically in pregnant women, especially in the second and third trimester.

Step 2: Identify that virus.
Hepatitis E virus spreads through contaminated water, which is common in areas with poor sanitation, including many parts of Bihar and other regions of India. In pregnant women, hepatitis E infection carries a much higher risk of fulminant hepatic failure, which can present as hepatic encephalopathy, jaundice, and a bleeding tendency, with a death rate that can reach 20 percent or more in the third trimester.

Step 3: Rule out HAV.
Hepatitis A virus also spreads by the fecal oral route and can cause acute hepatitis, but it does not carry the same sharply increased risk of fulminant failure in pregnancy that hepatitis E does.

Step 4: Rule out HBV.
Hepatitis B virus spreads through blood and body fluids and is important in pregnancy mainly because of the risk of passing the infection to the baby, not because it typically causes fulminant hepatic failure in the mother.

Step 5: Rule out HCV.
Hepatitis C virus usually causes a mild or even silent acute infection and is far more of a concern for chronic liver disease over years than for sudden liver failure during pregnancy.

Step 6: Final answer.
Given the water borne exposure typical of the region and the pattern of fulminant hepatic failure with encephalopathy in a pregnant patient, hepatitis E is the most likely cause.
\[ \boxed{\text{HEV}} \]