Gynecology

Hepatitis during pregnancy

د. حسين محمد جمعه
اختصاصي الامراض الباطنة
البورد العربي
كلية طب الموصل
2012

Fortunately, transmission of most forms of hepatitis via breastfeeding is rare.

Perinatal (mother-to-child around the time of delivery) transmission of Hepatitis A is rare, and there is no evidence for transmission through breastmilk. Some experts have advised giving the infant immune globulin if the mother has the onset of symptoms in the period from two weeks before to one week after delivery. Even without immune globulin, severe disease has not been reported in infants. Careful hand washing should still be emphasized to the mother.
Hepatitis A, even during the acute infectious period, is not a contraindication to breastfeeding.

Hepatitis B Virus (HBV)

Transmitted by sexual contact, perinatally, and rarely congenitally (mother-to-child during pregnancy). A major route of transmission from an infected mother to her baby is via contact with blood at the time of birth.


Chronic HBV virus infection occurs in as many as 90% of infants who become infected around the time of birth, and in
6-10% of older children, adolescents and adults who become infected in infancy and childhood. Chronically infected persons are at increased risk for developing chronic liver disease (cirrhosis, chronic active hepatitis, chronic persistent hepatitis) or liver cancer in later life.

Hepatitis B antibodies have been detected in breastmilk from women who test positive for Hepatitis B.
However, studies from Taiwan and England have shown that breastfeeding by Hepatitis B positive women does not significantly increase the risk of infection among their infants.

Infants born to known Hepatitis B positive women should receive Hepatitis B immune globulin (HBIG) and Hepatitis B vaccine (HBV) effectively eliminating any theoretical risk of transmission through breastfeeding.
Mothers with Hepatitis B should be encouraged to breastfeed.

All infants born to HBV-infected mothers should receive hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth. The second dose of vaccine should be given at aged 1–2 months, and the third dose at aged 6 months.

The infant should be tested after completion of the vaccine series, at aged 9–18 months to determine if the vaccine worked and the infant is not infected with HBV through exposure to the mother's blood during the birth process. However, there is no need to delay breastfeeding until the infant is fully immunized.
All mothers who breastfeed should take good care of their nipples to avoid cracking and bleeding.

Hepatitis C Virus (HCV)

An average of 50% of the patients develop chronic liver disease, including cirrhosis. Liver cancer may be associated with Hepatitis C as well as chronic Hepatitis B infections.

The risk of perinatal transmission is approximately 4 %

Overall, the risk of perinatal transmission of HCV appears extremely low.
Several recent studies demonstrate no increased risk of transmission caused by breastfeeding.


Is it safe for the HCV-positive mother to breastfeed if her nipples are cracked and bleeding?
Data are insufficient to say yes or no. However, HCV is spread by infected blood. Therefore, if the HCV-positive mother's nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. Instead, she should consider expressing and discarding her breast milk until her nipples are healed. Once her breasts are no longer cracked or bleeding, the HCV-positive mother may fully resume breastfeeding.

Urinary tract infections Asymptomatic bacteriuria is very common in pregnant women because of the altered dynamics of the urinary tract. If untreated, this frequently progresses to acute cystitis (1-2%) and/or pyelonephritis. The symptoms of acute cystitis are the same as in non-pregnant women:Frequency .Urgency Cloudy, smelly urine .Dysuria
Those of acute pyelonephritis are:
Pyrexia Rigors .Flank pain. Nausea & vomiting Headache .Frequency & dysuria

Management

Urine should be tested by dipstick. Confirmation is with urine microscopy and culture.Treat with trimethoprim, a cephalosporin or nitrofurantoin (except where otherwise contraindicated). In recurrent UTI, consider prophylactic nitrofurantoin but stop before delivery.
Consequences
premature labour and low birth weight.

The misconception that a pregnant patient should not undergo a chest radiograph is common. Risk to a fetus during chest radiography is minimal, but reluctance to image pregnant patients can delay diagnosis and affect outcomes.
BMJ October 2009