Hepatitis infection during pregnancy - PowerPoint Presentation

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Hepatitis infection during pregnancy

A

ssistant Professor Dr

Esraa

AL-

Maini

2016

Types

There are at least five distinct types of viral hepatitis

A, B,C,E D caused by the hepatitis B–associated delta agent Other hepatitis G virus (GBV-C) and TT virus do not cause hepatitis. All are RNA viruses except hepatitis B is DNA

Hepatitis B

-This infection is found worldwide but is endemic in Asia and Africa.

Transmitted by exposure to blood or body fluids ( serum is the most efficient).In endemic area vertical transmission from mother to fetus or new born account for 35-50% of chronic infection

In low prevalence country sexual transmission or sharing needle is the most frequent mode of transmission

clinical features:

IP 8-12 weeks

50% are

asymptomatic or mild symptoms in the reminder, fulmenint

hepatitis (50% caused by hepatitis B)

3-4 months

complete resolution

in more than 90% ,

10%

chronic infection

is often

Asymptomatic

but may be clinically suggested by, persistent anorexia ,arthritis ,

Chronic persistent hepatitis

Cirhosis

Hepatocellular

carcinoma.

Risk factors for chronic disease :

1-age 90% in newborn ,50% young children ,10%immune competent adult

Serology

Serology

HBsAg

: HBV surface antigen is present on the surface of the virus and also circulates in plasma.It is the first marker to be detected even preceding the increase in serum

aminotransferase, can be identified in serum 30 to 60 days after exposure to HBV and persists for variable periods

HBsAg

is not infectious

HBsAg

is detectable in serum in almost all cases of

acute and chronic HBV .

As HBS-Ag disappears antibody anti HBS appear during convalescence

Antibody to

HBsAg

(anti-HBs) develops after acute HBV infection complete resolution of disease or following hepatitis B vaccination. The presence of anti-HBs indicates immunity to HBV.

Hepatitis B core

antigen is an intracellular antigen and not detected in

serum

by conventional techniques, but it can be detected in liver tissue of persons with acute or chronic HBV infection.Antibody to HBc Ag (anti-HBc

): indicates infection with HBV at an undefined time in the past. IgM class antibody to

HBcAg

(

IgM

anti-

HBc

) indicates recent infection with HBV. Anti HBC is detectable within weeks of HBS Ag appearance

HBeAg

:

a soluble protein, is also contained in the core of HBV.

HBeAg is detected in the serum of persons with high virus titers and indicates high infectiviyThe H Be antigen is present during time of high viral replication and correlate with detectable HBV DNA . Antibody to HBeAg (anti-

HBe) becomes detectable when HBeAg is lost and is associated with low infectivity of serum

Viral DNA is ready found in amniotic fluid and cord blood also found in the ovary.

Highest level were found in women who transmitted HBV to their fetuses .

In the absence of immune prophylaxis 10-20% of women positive for HBS Ag transmitted virus to their infant the rate increase to 90% if HBS Ag,

HBe Ag positive.Immune prophylaxis and HB vaccine given to infant to HB virus infected mother has decrease transmission dramatically and prevented 40% of infection .

High viral load 106-108/l and those HBV

eAg

positive have at least 10% vertical transmission regardless immune prophylaxis

To decrease vertical transmission in women at highest risk due to high vial DNA level some have recommended antiviral therapy (lamivudine cytidine

neocleotide analoge) which has been found to significantly decrease the risk of fetal infection

H B immunoglobulin

given

antipratum

has also been shown to be effective in decreasing transmission rate .

Infant born to

sero

positive mother are given

Ig very soon after birth ,this is accompany by the first of three dose of hepatitis B recombinant vaccine .  Transmission rate was not increased with breast feeding if vaccination was complete although virus present in breast milk HBV infection is not contraindication for breast feeding .

In high risk mothers who are

seronegative

for hepatitis B virus vaccine can be given during pregnancy the efficacy has been shown to be similar to that for non pregnant adult with over all

seroconversion rate approaching 95% after three doses. Traditional vaccination sechdule of 0-1-6 months may be difficult to complete during pregnancy and compliance rate decline after delivery so 0-1-4months can result in 90% seroconevrsion

rate.

Hepatitis A

Route of transmission

: Fecal–oral route, Food or water. The I P: 4 weeks. Individuals shed virus in their feces, and during viremia their blood is also infectious.

Early serological detection is by identification of IgM antibody that may persist for several months .

During convalescence,

IgG

antibody predominates, and it persists and provides subsequent immunity.

Infections

Are most often subclinical. When clinically apparent, nausea and vomiting, headache, and malaise may precede jaundice by 1 to 2 weeks ,low-grade fever is more common with hepatitis A.

When jaundice develops, symptoms usually improve.

Most fatalities are due to

fulminant

hepatic necrosis

, MR: 0.1-1%.

There is usually complete clinical and biochemical recovery with in1to 2 months in all cases of hepatitis A

Immunization

Active immunization

using formalin inactivated viral vaccine is more than

90-percent effective. recommend vaccination of susceptible persons: traveling to high-risk countries, drug users, food handlers, and those with chronic liver disease or clotting-factor disorders. Passive immunization

for the pregnant woman recently exposed by close personal or sexual contact with a person with hepatitis A is with 0.02 mL /kg immune globulin single dose given in usual dosage with in 2 weeks of exposure effective as

Ig

in both group

Still3-4%

may developed hepatitis

Perinatal

Outcome

There is no evidence that hepatitis A virus is

teratogenic Transmission to the fetus is negligible. Even so, Preterm birth may be increased

Neonatal cholestasis

has been reported.

Vertical transmission

may occur in neonatal intensive care units.

Although virus isolated from breast milk no case reports secondary to breast feeding

Hepatitis C

Six genotypes ,type 1 account for more than 70%

Transmission

:by blood and body fluid ,sexual transmission is inefficient Diagnosis :

HCV –RNA testing is now gold standard for diagnosis,anti HCV appear up to 15 weeksClinical features :

Usually asymptomatic or mild symptom or jaundice

Sequel: 80-90%will be chronically infected

20-30% progress to cirrhosis with in 20-30 years

In pregnancy:

Most pregnant women diagnosed with HCV have chronic infection

Infection increase the risk of :

Low birth weight Neonatal care unit admission

PTL Mechanical ventilation The primary adverse

perinatal

outcome vertical transmission to fetus and infant

0-3%if the mother is DNA negative

4-6%if the mother is DNA positive ,the risk increase if HIV positive mother

2/3 of prenatal infection occur

peripartum

-Internal electronic fetal heart rate monitoring should be avoided -Delivery mode are not associated with mother-child transmission.- Breast feeding not contraindicated -No licensed vaccine for HCV

prevention -Treatment with alpha interferon is contraindicated

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