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ABOG Exam - OB > Viral Hepatitis in Pregnancy > Flashcards

Viral Hepatitis in Pregnancy Flashcards

1
Q

Hepatitis A - type of virus

A

Small RNA virus

Incubation period 28 days

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2
Q

Hep A - transmission

A

Fecal-oral
Most often in household/extended family settings (children under age 6)
Poor hygiene/poor sanitation

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3
Q

Hep A - prognosis

A 
Serious complications uncommon
- 1% overall case-fatality ratio
- 2% in adults >50
Does not lead to chronic infection
- Can have prolonged/relapsing disease up to 6 months
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4
Q

Hepatitis B - type of virus

A

Small DNA virus (Dane particle)

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5
Q

Hep B - antigens

A

Surface antigen
Core antigen
e antigen

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6
Q

Hep B - surface antigen

A

Present on surface of virus

Circulates freely in serum in spherical and filamentous forms

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7
Q

Hep B - core antigen

A

Middle portion of Dane particle

Present only in hepatocytes, does not circulate in serum

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8
Q

Hep B - e antigen

A

Encoded by same portion of viral genome that codes for core antigen
Presence indicates extremely high viral inoculum and active virus replication

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9
Q

Hep B - transmission

A

Parenteral and sexual contact
- Serum, semen, saliva
Can be transmitted from surfaces up to 7 days

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10
Q

Hep B - risk of transmission w/ blood transfusion

A

1 in 137,000 units

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11
Q

Hep B - prognosis

A

Mortality from acute hep B - 1%
Adults - 85-90% have complete resolution
- 10-15% become chronically infected

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12
Q

Hep B - chronic infection

A

10-15% will have chronic infection

  • Most asymptomatic, no lab evidence of hepatic dysfunction
  • 15-30% of those - viral replication continues, persistence of e antigen
  • Risk development of chronic hepatitis and cirrhosis
  • 4-5k die annually of complications of chronic liver disease (including hepatocellular carcinoma)
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13
Q

Hepatitis C - type of virus

A

Small RNA virus
6 distinct genotypes identified
Incubation period 30-60 days

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14
Q

Hep C - transmission

A

Parenteral and sexual contact

- Blood transfusion, IV drugs

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15
Q

Hep C - risk of transmission w/ blood transfusion

A

1 in 1,000,000 units

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16
Q

Hep C - prognosis

A

Asymptomatic infection - 75%
50% progress to chronic infection
- Increased risk of developing B-cell lymphomas, cryoglobulinemia
- 20% lead to chronic active hepatitis or cirrhosis
- Unclear link to hepatocellular carcinoma

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17
Q

Hepatitis D - type of virus

A

Incomplete viral particle (RNA) that causes disease in presence of hep B
- Simultaneously (coinfection)
- After hep B (superinfection)
20-25% of chronic HBV will have HDV

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18
Q

Hep D - transmission

A

Blood

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19
Q

Hep D - prognosis

A

More severe disease
70-80% of those w/ chronic hep D develop cirrhosis and portal HTN
- 15% - rapid progression to cirrhosis w/in 2 years
Mortality from hepatic failure = 25%

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20
Q

Hepatitis E - type of virus

A

RNA virus

Incubation period 40 days

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21
Q

Hep E - transmission

A

Waterborne (fecal-oral)

Rarely in the US

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22
Q

Hep E - prognosis

A

Self-limited viral infection followed by recovery

Mortality rate w/ HIV 100%

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23
Q

Hep A - vaccine

A 
Recommended for adults at risk for HAV or its adverse consequences
- Chronic liver disease
- MSM, illegal drugs
- Travel or work in endemic countries
Inactivated virus
2 doses
94-100% immunogenic, highly effective
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24
Q

Hep A - post-exposure prevention

A

HAV immune globulin

HAV vaccination

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25
Q

Hep B - vaccine

A

Healthcare workers, dialysis patients, drug users, high-risk sexual activity, international travel
Antibody screening prior to vaccination not indicated
Inactivated virus
3 doses
95% seroconversion rate

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26
Q

Hep B - post-exposure prevention

A

Hep B immune globulin (HBIG)

HBV vaccine within 24 hours

27
Q

Symptoms of acute hepatitis

A 
Malaise
Fatigue
Anorexia
Nausea
RUQ or epigastric pain
28
Q

Physical findings of acute hepatitis

A 
Jaundice
Upper abdominal tenderness
Hepatomegaly
Dark urine
Gray or acholic stool
Fulminant hepatitis - signs of coagulopathy or encephalopathy
29
Q

Symptoms of chronic hepatitis/cirrhosis

A 
Jaundice
Muscle wasting
Ascites
Spider angioma
Palmar erythema
Hepatic encephalopathy
30
Q

Treatment of acute hepatitis - inpatient

A

Encephalopathy, coagulopathy, or severe debilitation
Nutrition
Correct fluid and electrolyte abnormalities
Correct coagulopathy - PRBCs, platelets, FFP/cryo
Limit activity, protect from upper abdominal trauma

31
Q

Treatment of acute hepatitis - outpatient

A

Reduce level of activity, avoid upper abdominal trauma
Maintain good nutrition
Avoid intimate contact w/ household members, sexual partners

32
Q

Acute hepatitis - general lab tests

A 
Marked increase in AST/ALT
Elevated bilirubin
Coagulation abnormalities
Hyperammonemia
Liver biopsy (rarely indicated) - extensive hepatocellular injury and inflammatory infiltrate
33
Q

Hep A - specific tests

A

IgM antibodies

IgG antibodies can persist after previous infection or vaccination

34
Q

Hep B - specific tests

A

HBsAg - appears 4 weeks before clinical symptoms, detectable for 1-6wks
Chronic carriers - persistence of HBsAg (>20wks), absence of anti-HBs antibody
- Non-carriers have slowly increasing titer of anti-HBs 10-12m after sAg has been cleared
- Do not coexist in serum
Core IgG antibody - only from natural infection, not protective
Core IgM antibody - present for 6 months

35
Q

HBsAg negative
Anti-HBc negative
Anti-HBs negative

A

No infection, susceptible to infection

36
Q

HBsAg negative
Anti-HBc positive
Anti-HBs positive

A

Immune due to natural infection

37
Q

HBsAg negative
Anti-HBc negative
Anti-HBs positive

A

Immune due to vaccination

38
Q

HBsAg positive
Anti-HBc positive
IgM anti-HBc positive
Anti-HBs negative

A

Acutely infected

39
Q

HBsAg positive
Anti-HBc positive
IgM anti-HBc negative
Anti-HBs negative

A

Chronically infected

40
Q

HBsAg negative
Anti-HBc positive
Anti-HBs negative

A

4 interpretations:

  • Recovering from acute infection
  • Distantly immune - can’t detect low level of anti-HBs
  • Susceptible with false-positive anti-HBc
  • Undetectable HBsAg in serum, actually chronically infected
41
Q

Hep C - specific tests

A

Antibody to virus using ELISA
- 6-10wks after onset of clinical illness
Can test for specific RNA genotyping

42
Q

Hep D - specific tests

A

D antigen in hepatic tissue or serum
IgM antibody
Viremia and end-organ damage can continue despite antibody

43
Q

Hep E - specific tests

A

Antibody in those w/ risk factors

44
Q

Treatment of chronic carriers in pregnancy

A

Referral to GI - counseling and targeted treatment after delivery
Inform contacts of status, use methods to reduce risk of transmission
Report to health department

45
Q

Rate of vertical HBV transmission without prophylaxis

A

10-20% of women HBsAg positive

90% of women HBsAg and HBeAg positive

46
Q

Risk of chronic HBV if acquired perinatally

A

85-95%

25-30% risk of serious or fatal liver disease

47
Q

Timing of acute HBV infection and vertical transmission rates

A

1st trimester - 10%

3rd trimester - 80-90%

48
Q

Infant HBV vaccination timing

A

If mother negative - before discharge or <2 months
- Preterm or <2000g - delay until 1 month
If mother positive - HBIG and HBV vaccine w/in 12 hours of birth
- 2 more HBV vaccine before 6 months

49
Q

Efficacy of immunizations to prevent perinatal transmission

A

85-95%

50
Q

Prevalence of HCV in pregnant women worldwide

A

0.6-6.6%

51
Q

Rate of vertical HCV transmission

A

2-8%

Rare if mother HCV RNA negative

52
Q

Rate of vertical HCV transmission if coinfected with HIV

A

44%

53
Q

Risk factors for vertical HCV transmission

A

Higher maternal HCV viral titer
Prolonged ROM (>6 hours)
Internal fetal monitoring during labor

54
Q

Prevention of vertical HCV transmission

A

No available prevention measures

55
Q

Indications for HCV screening

A

Ever injected illegal drugs
Received blood products before 1987 or from a donor who tested positive for HCV
Received transfusions or organ transplants, especially before July 1992
Long-term hemodialysis
Persistently elevated LFTs or other evidence of liver disease
Seeking evaluation or care for an STI, including HIV

56
Q

Mode of delivery for HCV

A

Not an indication for C/S

57
Q

Amniocentesis in HBV and HCV

A

Small studies show low risk of transmission, however limited

Should discuss non-invasive options

58
Q

Breastfeeding in patients with hepatitis

A

HAV - permissible w/ appropriate hygiene
HBV - not contraindicated if infant receives ppx
HCV - not contraindicated

59
Q

HAV exposure in pregnancy

A

HAV immune globulin - as soon as possible
- Protection up to 3 months with 80-900% efficacy
HAV vaccine

60
Q

HBV treatment in pregnancy

A

No specific therapy

- Current investigations into lamivudine or HBIG to prevent in utero HBV infection

61
Q

HCV treatment in pregnancy

A

No current therapy

- Current investigations into interferon

62
Q

Occupational exposure to HBV

A

HBV has highest concentrations in blood and requires much smaller volumes for transmission
Risk of infection w/ injury is 20-30%
All health care workers should be vaccinated

63
Q

Occupational exposure to HCV

A

Risk is lower than HBV but higher than HIV

ABOG Exam - OB (4 decks)

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