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 Markers	Significance
HBsAg	Continued presence indicates carrier state
HBsAb	immunity to HBV
HBcAb	IgM (+) during window periodIgG HBcAb 🡪prior or current infection
HBeAg	replication & transmissibility (Beware!)
HBeAb	low transmissibility
HBV (DNA)	Viral load

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.

  

Viral Hepatitis-D in Pregnancy

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

 

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.

Viral Hepatitis in Pregnancy (HAV, HCV, HEV)