目的:探讨妊娠中晚期重型病毒性肝炎对孕妇及胎儿预后影响及防治措施。方法:回顾性分析54例妊娠中晚期重型病毒性肝炎患者的临床及实验室资料。结果:HBV相关、HEV相关、重叠感染率分别为66.67%、25.93%、29.63%;总病死率为68.52%,急性、亚急性及慢性妊娠期重肝的病死率分别为85.71%、80.00%、56.67%,中晚期妊娠患者病死率分别为68.75%、68.42%,各组间比较无统计学差异(P>0.05);存活组和死亡组在凝血酶原时间(PT)、血清总胆固醇(CHOL)及肝脏体积缩小等比较有统计学差异(P<0.05),并发症发生频率排位:肝性脑病、感染、肝肾综合征、DIC、产后大出血,并发症数量增多则病死率升高;胎儿总死亡率48.15%,其中HBV感染相关的死亡率55.56%。结论:本组病例以HBV、HEV感染最常见,孕产妇及胎儿死亡率高;妊娠中晚期重型病毒性肝炎孕妇转归与PT、CHOL、肝脏体积大小、并发症的数量有关,胎儿预后可能与HBV感染及高胆红素血症有关;避免妊娠中晚期重型病毒性肝炎发生的关键在于早期预防和治疗肝炎病毒感染。 Objective: To investigate the prognosis of pregnant women and fetuses with severe viral hepatitis in the second and third trimester of pregnancy and its preventive measures. Methods: The clinical and laboratory data of 54 patients with severe viral hepatitis in the second trimester of pregnancy were retrospectively analyzed. Results The rates of HBV-related and HEV-related infections were 66.67%, 25.93% and 29.63%, respectively. The total case fatality rate was 68.52%. The case fatality rates of severe, subacute and chronic severe hepatitis were 85.71% and 80.00% 56.67%, respectively. The case fatality rates in middle and late pregnancy were 68.75% and 68.42%, respectively. There was no significant difference between the two groups (P> 0.05) ) And liver size (P <0.05). The frequency of complications was: Hepatic encephalopathy, infection, hepatorenal syndrome, DIC, postpartum hemorrhage. The increase of the number of complication increased the case fatality rate. The total fetal mortality rate was 48.15%, of which HBV infection-related mortality was 55.56%. Conclusion: HBV and HEV infection are most common in this group of cases, with high maternal and fetal mortality rates. The prognosis of pregnant women with severe viral hepatitis in the second and third trimester of pregnancy is related to the number of PT, CHOL, liver volume and the number of complications. The prognosis of fetuses may be related to HBV infection and hyperbilirubinemia; the key to avoid the occurrence of severe hepatitis in the late pregnancy is early prevention and treatment of hepatitis virus infection.