Viral Hepatitis In Pregnancy

Question 1

What is the rate of mother to child transmission in HBV + women?

Answer 1

HBsAg +& HBeAg+ 👉95%
HBsAg+& HBeAg - 👉 2 - 15 % (10%)

Question 2

When is mother to child transmission MTCT in HBV usually occurred?

Answer 2

Usually at delivery
Transplacental only 5%

Question 3

What is the consequences of the neonate being infected with HBV at birth?

Answer 3

> 90% chance of becoming chronic carriers of HBv with associated risk of subsequent cirrhosis & hepatocellular carcinoma.

Question 4

What is the most sensitive test of viral infection in HBV ?

Answer 4

Measurement of HBV-DNA
Vertical transmission is higher with higher viral load

Question 5

What is the neonatal management in women with HBV ?

Answer 5

Hepatitis B immunoglobulin
+ HBV vaccine WITHIN 24h of birth

Question 6

What is the benefits of
Immunization the neonates at birth?

Answer 6

85 - 95 % effective at preventing both HBV infection & chronic carrier state

Question 7

How about breastfeeding in women with HBV ?

Answer 7

No need to prevent breastfeeding in
Immunized babies

Question 8

What are the conditions that considered of [ infant high risk of vertical transmission] That indicate HBIG ?

Answer 8

1- maternal HBeAg positive
2- maternal anti- HBe negative or unknown
3- maternal HBV DNA >1×10⁶ IU/mL
At any time in pregnancy
4- acute maternal HBV infection during pregnancy ( anti- HBc IgM positive)
5- birth weight < 1500 g

Question 9

What are the indications for treatment in women with HBV during pregnancy?

Answer 9

1- HBV DNA > 200,000 IU / ml
2- HBsAg > 4 log Iu
❤ from 24 w TENOFOVIR disoproxil
TD ( antiviral)

Question 10

HBs Ag + presence indicates…?

Answer 10

Acute or chronic infection
Means that the person in infectious

Question 11

HBe Ag + presence indicates…?

Answer 11

Marker of active viral replication
Usually associated with high viral load ( high HBV DNA )

Question 12

HBs Ag + & anti-HBs + indicates…?

Answer 12

Recovery and immunity from HBV infection

Question 13

HBs Ag - & anti-HBs + indicates …?

Answer 13

After vaccination against HBV

Question 14

Anti-HBc presence indicates..?

Answer 14

Previous or ongoing infection
Appears at the onset of the symptoms in acute phase and persist for life
📌anti-HBc IgM👉 recent infection
( < 6 months)
📌 if it is positive without( HBsAg or anti-HBs ) 👉 1- resolved infection
2- false positive
3- low level chronic infection

Question 15

Anti-HBe presence indicates…?

Answer 15

Associated with lower viral load ( low HBV DNA)

Question 16

What is the risk rate of vertical transmission in HCV ( hep- C)?

Answer 16

3- 5 % of cases
20 % if co-infected with HIV

Question 17

What is the major risk of HEV ( hep-E) in pregnancy?

Answer 17

Fulminant hepatic failure 15-20% with maternal mortality 5 %+ hepatic encephalopathy ESPECIALLY: if the virus is acquired in 3rd trimester

Question 18

CASE:
32 w from Mumbai: jaundice/ fatigue / nausea 👉 fulminant hepatic failure & encephalopathy 👉dies

Answer 18

Hepatitis E
( faecal - oral route)

Question 19

CASE:
Ongoing pruritus from 12 w / positive Anti - mitochondrial antibodies

Answer 19

Primary biliary cholangitis

Question 20

CASE:
12 w + fever + vomiting
⬆️ transaminas ⬆️ bilirubin

Answer 20

Viral Hepatitis