HBV in Pregnancy

Question 1

A 34-year-old Asian lady G2P1 24 weeks’ gestation is found to be Hep B positive in her antenatal testing. What would be your management? What would be your concerns and follow-up for the foetus?

Answer 1

Impression
Several implications for HepB positive patients in pregnancy. Implications for both maternal and fetal health.

Vertical transmission can occur during pregnancy, during delivery. main aim is to prevent vertical transmission, and to manage mothers symptoms and prevent complications.

Question 2

HBV in pregnancy - History

Answer 2

History

• sx: RUQ pain, jaundice, fevers, arthralgia, malaise, N/V
• REDFLAGS: confusion, cirrhosis, liver failure
• Risk Factors: IVDU, sexual history
• O&G history: GTPAL, yellow card
• PMHx, PSHx
• Psychosocial history

Question 3

HBV in Pregnancy - Investigations

Answer 3

Examination

• General appearance + vital signs
• Antenatal assessment
• abdominal examination: stigmata of liver disease, hepatosplenomegaly, RUQ tenderness

Question 4

HBV in pregnancy - Investigations

Answer 4

Investigations
- Key/Diagnostic: Hepatitis serology (surface and core antigen/antibody)

Risk of transmission
- HBV viral load - shows degree of replication and infectivity

• Bedside: CST, STI screening,
• Bloods: FBC, LFT, UEC, other antenatal screening
• imaging: Abdo ultrasound

Question 5

HBV in Pregnancy - Managemetn

Answer 5

Management
Would enlist support of multidisciplinary team including;
- high risk pregnancy unit
- chronic hepatitis clinic
- avoid invasive procedures
- test HBV viral load, if high then administer antiviral prophylaxis from ~30wks gestation
- C-section is not indicated for reducing risk of vertical transmission of HBV
- administer HepB vaccine + HepB Immunoglobulin to neonate within 12 hours, follow up with Hep B serology to

Consider/supportive

• Psychosocial support and referral
• regular review and follow-up