Hepatitis B IN PREGNANCY- Etiopathogenesis and Management.pptx

HBsAg pregnancy

1. HBsAg IN PREGNANCY A PRESENTATION BY DR. SHIVANI V MODERATOR: DR VIJAYALAKSHMI

2. HEPATITIS B VIRUS dsDNA virus Hepadnaviridae 4 genes ~ S gene: HBsAg/ surface protein ~ P gene: DNA polymerase/ enzyme protein ~ C gene: HBeAg (nucleocapsid protein) and HBcAg (core protein) ~ X gene: X protein ( HBxAg ) transactivates the transcription 8 genotypes (A-H)

3. PATHOPHYSIOLOGY OF HBV

4. TRANSMISSION: Via body fluids Vertical transmission INCUBATION PERIOD: 30-180 days CLINICAL PICTURE: Asymptomatic- 75% Acute hepatitis- prodromal symptoms, RUQ pain, fever, arthralgia, rash, jaundice, nausea and vomiting, pruritus Chronic hepatitis- (10% in adults/ 80% in children) : hepatitis, hepatoma, liver cirrhosis, HCC. Fulminant hepatitis(2-5% in adults) : Hepatic failure  Death.

5. HEPATITIS B IN PREGNANCY: 1-2 per 1000 pregnancies Carriers: 0.5-1% EFFECTS: LBW Low APGAR scores Birth asphyxia Prematurity Still birth GDM Antepartum hemorrhage Preterm delivery/ PROM

6. DIAGNOSIS: ROUTINE SCREENING OF ALL ANTENATAL MOTHERS FOR HBsAg LOW RISK MOTHERS HIGH RISK MOTHERS NEGATIVE NEGATIVE POSITIVE POSITIVE TREAT AS CASES ANOTHER SCREENING AT 28 WEEKS POSITIVE NEGATIVE

7. PREVENTION: LOW RISK MOTHERS: HBV Vaccination during or after gestation can be advised. HIGH RISK MOTHERS: Counsel her for HBV vaccination. HBV VACCINATION: 3 DOSES At weeks 0,4,24 Given intramuscularly (preferably left deltoid) Dose: 0.5mL

8. TREATMENT OF HBV INFECTION IN PREGNANCY Other investigations: HBeAg , HBcAg , Anti HBc

9. TREATMENT FOR FETUS IN HBSAG INFECTED MOTHERS

10. REFERENCES Arias’ Practical Guide to High risk Pregnancy and Delivery- 5 th edition Ian Donald’s Practical Obstetric Problems- 8 th edition Borgia G et al. Hepatitis B in pregnancy World J Gastroenterol 2012 Sep 14; 18(34): 4677–4683. AIIMS Protocol in Neonatology 2 nd edition

11. THANK YOU 