VIRAL HEPATITIS-B IN PREGNANCY & (HDV)

Viral Hepatitis-B in Pregnancy

Viral Hepatitis-B in pregnancy can cause serious events in Childbirth and in Child’s as well as mother’s health. Proper management is required with safe delivery as well as proper timely immunization.

Epidemiology

  • 400 million individuals have chronic. HBV worldwide
  • Out of which 50% acquired their infections perinatally
  • 3.5% of pregnant mothers in BD are carrying the HBV (National Liver foundation BD)
  • 90% of infected infants will become chr. carriers of HBV 
  • 2nd carcinogens after tobacco (WHO) 

Etiology 

Double-stranded DNA virus 

Hepa DNA virus whose DNA codes for four viral products. 

Incubation period 

About 1-2 months.

Long (up to 180 days)

Clinical picture of Viral Hepatitis-B in Pregnancy

  • Majority of the cases are asymptomatic
  • Acute infection: ±asymptomatic and anicteric 
  • Most infections during pregnancy: chronic, asymptomatic
  • Physical Exam 
    • Urticarial rash 
    • Arthralgias and arthritis 
    • Myalgias 
    • Hepatomegaly and/or right upper quadrant tenderness 
    • Jaundice is less common

    

Clinical course of viral Hepatitis-B infection

  • After acute hepatitis 
    • 90%: recover completely. 
    • 10%: chronic hepatitis B: 
      • ¼ chronic liver disease 
  • HBeAg positive: at greatest risk for HCC
Serological MarkersSignificance
HBsAgContinued presence indicates carrier state
HBsAbimmunity to HBV
HBcAbIgM (+) during window periodIgG HBcAb 🡪prior or current infection
HBeAgreplication & transmissibility (Beware!)
HBeAblow transmissibility
HBV (DNA)Viral load
Serological Markers for Hepatitis B

Impact of Viral Hepatitis-B in Pregnancy.

  • Preterm delivery

Impact of Pregnancy on HB

  • Hepatic exacerbation/fulminant hepatitis 

Transmission 

  1. Perinatal/ Vertical Transmission Neonates
  2. Horizontal Transmission
  3. Sexual 
  4. Parenteral 

Management of Viral Hepatitis-B in Pregnancy

During pregnancy

  • Supportive therapy
    • Counselling
    • Dietary modifications
    • Maintenance of Normoglycaemia 
    • Vitamin supplementation
  • Specific therapy:
    • Antivirals
      • Telbivudine
      • Tenofovir 
  • Interferons
    • Peg. Inf. Alfa (not recommended in pregnency)
  • Others:
    • Regular monitoring of Hypokalaemia, Hypoglycaemia, Hypocalcaemia
    • Blood transfusion and FFP
    • Parenteral
      • Vit-K to raise Prothrombin time
      • Prophylactic ergometrine

During labour 

  • To minimize vertical transmission delivery should be as Atraumatic as possible.
  • Things to be avoided
    • Fetal scalp blood sampling
    • Scalp electrode
    • Ventouse delivery
    • Vigorous resuscitation of baby using sucker (causes injury to the pharynx)
  • NO indication for elective C/S

Post delivery

  • Bathe the baby- just after delivery
  • Post Exposure Prophylaxis (PEP) to neonate
    • neonates of mothers who are HBsAg positive should receive the vaccine and HBIg within 12 hours after birth & complete doses.
  • Breast feeding:
    • It’s not contraindicated in neonates who’re properly immunized within 12 hrs after delivery.

  

Algorithm for Mx. Of Pregnancy. With Hepatitis B (AASLD)

Viral Hepatitis-D in Pregnancy

  • Stands for Hepatitis Delta virus
  • Is a RNA Defective virus
  • Coexists or Super infects with HBV

 

Update on global epidemiology of viral hepatitis and preventive ...
Hepatitis D prevalence

Investigation

  • Usually done in pt. screened to be positive for HBV
  • Anti HDV Ab.

Mode of transmission

  • Parenterally
  • Sexually
  • Exposed to unscreened blood and body fluids.

Management

  • Pregnant. women
    • Supportive Mx. as in HBV.
      • Counselling
      • Dietary modifications
      • Maintenance of Normoglycaemia 
      • Vitamin supplementation
      • Others.
  • Effective Mx. of HBV prevents Hepatitis D.

How to prevent transmission of HDV in Neonate?

  • Similar to the post delivery mx. of HBV
  • Vaccination against HBV to neonate is the main stay of Rx.

Also for more info:

https://medlineplus.gov/hepatitis.html#:~:text=Hepatitis%20is%20an%20inflammation%20of,healthy%20cells%20in%20the%20liver.

For information on HAV, HCV,HEV during pregnancy.