Ebook Comprehensive textbook of hepatitis B: Part 2
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Ebook Comprehensive textbook of hepatitis B: Part 2
16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2 of Asia, as prevalence of hepatitis B ranged from 4 to 20% in various parts of Asia. It is nor uncommon for physicians to encounter pregnant hepatitis B patients in their clinical practice. Besides, maternal-fetal transmission is considered the major source of transmission of hepatitis B in Asia. H Ebook Comprehensive textbook of hepatitis B: Part 2ence, it is important for physicians to be aware of hepatitis B management before, during, and after pregnancy.PREPREGNANCY MANAGEMENTPhysicians mustEbook Comprehensive textbook of hepatitis B: Part 2
be aware that none of the antivirals against hepatitis B are classified as FDA pregnancy category A. In patients with chronic hepatitis B requiring an16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2s such as nucleoside or nucleotide analogs are often given over prolonged period of up to a few years in duration.Therefore, before treating female hepatitis B patients in the reproductive age group, physicians must discuss the potential benefits of antivirals, the possible need for prolonged admini Ebook Comprehensive textbook of hepatitis B: Part 2stration of antivirals, and the insufficient safety data of antivirals dur ing pregnancy with both the patient and the spouse. In patients having mildEbook Comprehensive textbook of hepatitis B: Part 2
liver disease, it may be better to wait till the patient has completed her family before administering oral antivirals. Alternatively, physicians can16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2e. In patients with severe liver disease and oral antivirals are being administered, it is prudent to ask patients to consider using contraceptives while they are on antiviral treatment.WHEN A HEPATITIS B INFECTED PATIENT BECOMES PREGNANTThe Advisor}- Committee on Immunization Practices (AICP>. whic Ebook Comprehensive textbook of hepatitis B: Part 2h advises the Center for Disease Control and Prevention (DCD) on the control of vaccine-preventable diseases, recommends that all pregnant women be teEbook Comprehensive textbook of hepatitis B: Part 2
sted foi HBsAg during an early prenatal visit in each pregnancy, irregardless of whether the}- have158 II Comprehensive Textbook of Hepatts 8been vacc16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2ng and USA have shown that both maternal and neonatal outcomes in mother with chronic hepatitis B were comparable to non-hepatitis B mothers.Among all antivirals against hepatitis B. telbivudine and tenofovir are classified as FDA pregnancy category B drug However, safety data of both of them among Ebook Comprehensive textbook of hepatitis B: Part 2pregnant hepatitis B carriers are lacking. Lamivudine. though classified as category' c. has the longest safety record among pregnant women, and shoulEbook Comprehensive textbook of hepatitis B: Part 2
d be used as first-line antiviral agent during pregnancy. After delivery, lamivudine can be switched to mote potent drugs such as entecavir or tenofov16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2 2.7%. a rate comparable to that in unexposed pregnant females.While some patients may be worried about the lack of safety data of antivirals, the thought of stopping antivirals must be balanced with the risk of withdrawal flares when antivirals are stopped prematurely.Other hepatitis B patients who Ebook Comprehensive textbook of hepatitis B: Part 2m are not on antiviral treatment should be monitored as per normal, with liver panel and ultrasound scan being tested every 6 months. During pregnancyEbook Comprehensive textbook of hepatitis B: Part 2
, alkaline phosphatase level may be mildly elevated, and albumin may be slightly depressed, even in the absence of significant liver disease.RISKS OF 16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2 neonates bom to HBsAg+ve/ HBeAg-ve. became hepatitis B carriers. Since the introduction of active (intramuscular administration of 3 doses of recombinant hepatitis B vaccine 0.5 microgram within 12 hours of birth, then at 1 and 6 months of age) and passive vaccination (intramuscular administration Ebook Comprehensive textbook of hepatitis B: Part 2of hepatitis B immunoglobulin. HBIG. 0.5 ml within 12 hours of birth), the risk of vertical transmission has dropped to <10%.Failuie of 100% preventioEbook Comprehensive textbook of hepatitis B: Part 2
n is thought to be due to ưansplacental leakage of hepatitis B virus, also known as “intrauterine transmission". Intrauterine transmission occuned bef16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2emia, with hepatitis B mother being HBeAg-ve and high serum HBV DNA level being at highest risk.Several measures have been proposed to reduce such risk Maternal administration of HBIG 200 If at weeks 28th. 32nd. and 36th. together with standard practice of neonatal active-passive immunoprophylaxis, Ebook Comprehensive textbook of hepatitis B: Part 2was shown to be effective in several studies from China m reducing risk of vertical transmissionIiepatilfe B II Pregnancy 1159to <5%. Administration oEbook Comprehensive textbook of hepatitis B: Part 2
f lamivudine after week 34th has been showed m several studies as equally effective in reducing risk of imrauterine transmissionIl lias to be emphasiz16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2 lamivudine are of I- DA pregnancy category (■ and their use in pregnant patients should be considered experimental and be given only as pan of a clinical study.MODE OF DELIVERY: ELECTIVE CESAREAN SECTION vsVAGINAL DELIVERYDuring labor, mother-to-child transmission could potentially occur through mi Ebook Comprehensive textbook of hepatitis B: Part 2crotransfusion of maternal blood into the baby, neonatal swallowing of circulation tear of placenta, amniotic fluid, or vaginal secretions while passiEbook Comprehensive textbook of hepatitis B: Part 2
ng through birth canal. It has been postulated that risk of transmission during labor could be reduced by cesarean section. However, the efficacy of e16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2ve active-passive immunoprophylaxis given to newborns from birth, it is unknown if elective cesarean section can provide any further benefits. Weighing against the risk of increased maternal and neonatal morbidity and mortality, we do not recommend elective cesarean section as the mode of delivery i Ebook Comprehensive textbook of hepatitis B: Part 2n hepatitis B mothers purely for the reason of reducing maternal-fetal transmission rate.POSTPARTUM HEPATITIS B FLARESThere is a tendency for HBV DNAEbook Comprehensive textbook of hepatitis B: Part 2
titer to increase during pregnancy, and drop after delivery. Liver transaminases also tend to drop during pregnancy, but then increase after delivery.16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2was thought to be due to reconstinition of rhe immune system. Decompensation can occur in severe flares so mothers with chronic hepatitis B ought to be closely followed up after theft delivery.BREASTFEEDINGHepatitis B virus can be found in breast milk in some mothers with hepatitis B. But risk of tr Ebook Comprehensive textbook of hepatitis B: Part 2ansmission from mother to child through breast milk has not been shown in large scale clinical studies In fact, in several case coaưol studies, no difEbook Comprehensive textbook of hepatitis B: Part 2
ference in infection rales betw een breastfed and bottlefed infants of hepatitis B mothers was found. It is postulated that newborns of hepatitis B mo16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2hing against the vast benefits of breastfeeding to both the mother and the newborn, the American160 II Comprehensive Textbook of Hepatite BAcademy of Pediatrics recommended that maternal hepatitis B being not a contraindication to breastfeeding.UVER CANCER IN PREGNANCYHepatocellular carcinoma (HCC) Ebook Comprehensive textbook of hepatitis B: Part 2IS a complication of chronic hepatitis B. and can occasionally occurr in pregnant women. Prognosis for HCC was particularly poor with 1 year survivalEbook Comprehensive textbook of hepatitis B: Part 2
being <20%. which was thought to be due to tumorpromoting effects of estrogen. Ultrasonography is the initial investigation in pregnant patients suspe16Ể&a/btenHepatitis B in PregnancyDesmond ĩỉdi. Kai-Chah TanINTRODUCTIONChronic hepatitis B is a major cause of morbidity and mortality in many parts Ebook Comprehensive textbook of hepatitis B: Part 2protein (AFP) level can be elevated for obstetric causes, such as miscarriage and fetal neural tube defects so a mildly elevated AFP does not equate presence of liver cancer. Treatment of choice is termination of pregnancy followed by resection, if applicable. Ebook Comprehensive textbook of hepatitis B: Part 2Gọi ngay
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