Abstract
The causes of maternal mortality are direct or indirect. It is important to investigate the causes of maternal mortality as maternal mortality is an indicator of nation health. Reviewing and analyzing the causes of maternal deaths we can find out areas to improve our health care system and this is crucial for reduction in maternal mortality. The aim of the study is to determine the causes of maternal mortality in Shalamar hospital Lahore. Method: Study conducted for the duration of one year from January 2018 to February 2019 in Shalamar hospital Lahore. All the pregnant ladies who became seriously ill during pregnancy and shifted to intensive care unit of hospital for management were included in the study. Causes of critical illness and outcome of critically ill pregnant ladies who were shifted to intensive care units were determined. Results: During study period 24 patients shifted to ICU. Out of these 22 were discharged and 2 were expired in ICU. Cause of death is hepatitis E leading to hepatic failure in both patients. Conclusion: Hepatitis E infection in pregnancy is associated with poor maternal outcome

Keywords
hepatitis E,MATERNAL MORTALITY

Cite this paper
Dr. Shaherzad Sohail., Dr Lubna Raiz Dar., Dr Wajeeha Asghar Ali., Hepatitis E during pregnancy....An indirect cause of maternal mortality , SCIREA Journal of Clinical Medicine. Volume 4, Issue 3, June 2019 | PP. 87-93.

References

[ 1 ]	Say L et al.Global causes of maternal death:A WHO systematic analysis.Lancet Global Health.2014,2:323-33
[ 2 ]	Nour MN.Introduction of maternal mortality.Rev.Obstet.Gynaecol.2008,1:77-78
[ 3 ]	Storm F et al.Indirect causes of maternal death.The Lancet Global health.2014,2:566
[ 4 ]	Alkena L et al. Global, regional and national levels and trends in maternal mortality between 1990-2015 with scenario-based projection to 2030 a systematic analysis by the UN maternal estimation inter agency group. Lancet.2016,387:462-74
[ 5 ]	Pollock EW,Rose L,Dennis LC.Pregnant and post partum admission to the intensive care unitbAsystematic review.Intensive care medicine.2010,36:1465-74
[ 6 ]	Poorama B et al.Evaluation of obstetric admission to intensive care unit of a tertiaty referral center in coastal India.India J Crit Care Med.2013,17:34-37
[ 7 ]	Shrestha N et al.Maternal and perinatal outcome of pregnancy with hepatitis E infection. Journal of South Asian federation of Obstetrics and Gynaecology.2011,3:17-20
[ 8 ]	Patra S et al.Maternal and fetal outcome in pregnant women with hepatitis E virus infection. Ann Intern Med.2007,147:28-33
[ 9 ]	Nadar S,Shah MA,Jamil S,Habib H.Maternal and fetal outcome in pregnant ladies having acute hepatitis E.J Med Sci.2015,13:37-40
[ 10 ]	Jalal N et al. Hepatitis E virus infection and fulminant hepatic failure during pregnancy.J Gastroenntrol Hepatol.2007;221:676-82
[ 11 ]	Kumar A et al.Hepatitis E in pregnancy.International journal of Gynaecolgy and Obstetrics.2004;85:240-44
[ 12 ]	KarP. Hepatitis E virus infection during pregnancy .why is the disease stormy. Medicine update.2012;22:459-62
[ 13 ]	Styrt B,Suyarman B.Estrogen and infection.Rrv Infect Dis.1991;13:1139-350
[ 14 ]	Priddy ICD.Immunological adaptation during pregnancy.J ObstetbGynaecol Neonatal Nurs.1997;26:388
[ 15 ]	Jalani et al.Hepatitis E viral infection and fulminant hepatic failure during pregnancy.J Gasteroenterol Hepatol.2007;22:676-82
[ 16 ]	Naverthan U,Mohajer M,Shata TM.Hepatitis E and pregnancy.Liver Int.2008;28:1190-99
[ 17 ]	Yadav S,Shirodker S,Kshrsagar S.Maternal and fetal outcome in pregnancy with hepatitis E virus infection. Int. J Reprod contracept Obstet gynaecol 2016;5:3482-90
[ 18 ]	Chaudhry S,Verna N, K oren G.Hepatitis E infection during pregnancy.Can Fam Physician.2015;61:607-08
[ 19 ]	Banait VS et al. Outcome of acute liver failure due to acute hepatitis E in pregnant women. Indian j Gasteroenterol.2007;26:6-10
[ 20 ]	Deng L et al.Maternal and perinatal outcome in case of fulminant viral hepatitis in late pregnancy.International journal of Gynaecology and obstetrics.2012;119:145-48
[ 21 ]	Sultan R,Hamayun S.Fetomaternal outcome in acute hepatitis E.J Coll. Physician Surg Pak.2014;24:127-30
[ 22 ]	Kuhroo MS,Kamili S. Etiology, clinical coarse and outcome of sporadic acute viral hepatitis in pregnancy.J Viral Hepat 2003;10:61-9
[ 23 ]	Rein DB et al. The global burden of Hepatitis E virus genotype 1 and 2in 2005.Hpatology,2012;55:988-97
[ 24 ]	Labrique B A et al.Hepatitis E a vaccine preventable cause of maternal death. Emerg Infect Dis.2012;18:1401-04
[ 25 ]	Madan A,Soni S,Dogia A U,Neki S N.Prevalance of viral hepatitis in pregnancy an observational study.International journal of research in medical sciences 2017;396-104