Viral Hepatitis/Hepatitis B

Question 1

Define Hep B in pregnancy.

Answer 1

Infection caused by the Hep B virus

Question 2

Explain the aetiology of Hep B in pregnancy.

Answer 2

Transmission by sexual contact, blood borne, vertical.

Question 3

What are the risk factors for Hep B in pregnancy?

Answer 3

Multiple partners, unprotected sex, IVDU, SE Asian.

Question 4

Summarise the epidemiology of Hep B in pregnancy.

Answer 4

1/100k pregnancies

Question 5

What are the symptoms of Hep B in pregnancy?

Answer 5

Fever, myalgia, N&V, jaundice, abdominal pain

Asymptomaic in 70%

Question 6

What are the signs of Hep B in pregnancy?

Answer 6

Jaundice

Hepatomegaly

RUQ tenderness

Question 7

What investigations are performed for Hep B in pregnancy?

Answer 7

Bloods: HbsAG (infection), core Ab (anti-HBc IgM acutely), Hep B e-markers (HbeAg – high infectivity strain), LFTs

Question 8

What is the management for Hep B in pregnancy?

Answer 8

Delivery: C-section NOT INDICATED, avoid fetal blood sample (FBS) and fetal scalp electrode (FSE).

Postnatal: Mothers can breastfeed.

Neonatal vaccination: IF mother is HbsAg positive at birth, 1 month, 2 months and booster at 1yr.

Neonatal HBIG: Within 48h of delivery, if BW <1500g, if acute infection in pregnanct, if mother is HbeAg positive (or HbeAg negative but anti-HbeAg negative).

Question 9

What are the complications for Hep B in pregnancy? What is the prognosis for Hep B in pregnancy?

Answer 9

Maternal: 10% chronic cirrhosis, hepatitis. High risk of HCC. 1% fulminating hepatitis.

Neonates: 90% develop chronic hepatitis

With treatment, vertical transmission rate 10%.