Hepatitis

Question 1

Hepatitis B

Answer 1

Testing in all women (vertical transmission rate = 20%; 90% if +ve for HBeAg)

• Part of routine antenatal screening programme at booking

Asymptomatic but may show some signs of liver dysfunction (jaundice, hepatomegaly)

Ix: Bloods (esp LFTs), Hep B serology, PCR (viral load)

Antenatal care

• Offer tenofovir disoproxil to women with HBV DNA > 107 IU/mL in the 3rd trimester (to reduce the risk of transmission to the foetus)
• STOP 4-12 weeks after birth unless mother meets criteria for long-term treatment

Babies born to chronically infected mothers or mothers with acute hepatitis B during pregnancy should receive:

• Vaccination (given at birth, 1 month, 6 months  serological test for HBV at 12 months)
• HBV IVIG (0.5mL within 12 hours of birth)

C-section does not reduce vertical transmission (however, it’s indicated in cases of HIV + hepatitis B coinfection)

Hepatitis B is NOT transmitted via breastfeeding (and can continue on antiviral treatment)

Question 2

Hepatitis C

Answer 2

Vertical transmission can occur due to contact with infected maternal blood at time of delivery but UNCOMMON

Not routinely screened for unless HepB positive

RFs - IVDU, Blood transfusions, Tattoos, Body Piercings

Most are asymptomatic

Ix: Bloods (LFTs esp), Detect anti-HCV antibodies, Confirm with PCR for the virus

Treatment contraindicated in pregnancy (ribavirin + interferon)

• Deferred to the post-partum period
• No specific precautions are recommended: there is LOW risk of vertical or blood transmission from mother to foetus
• Elective Caesarean section is NOT recommended unless co-infected with HIV

Question 3

Hepatitis E

Answer 3

in pregnancy – i.e. pregnant mothers stay away from pork and shellfish

Causes a severe reaction if contracted in the third trimester – sometimes a fulminant hepatitis