Book of Medical Disorders in Pregnancy - Tintash

Immunoprophylaxis at birth followed by
a hepatitis B vaccination series reduces
vertical transmission of hepatitis B virus
to less than 3 percent. Disseminated
HSV infection is associated with prodromal
systemic illness, vesicular skin
rash and leukopenia. Maternal and fetal
mortality rates reach 50 percent without
treatment. Acyclovir (Zovirax) effectively
treats early disseminated HSV infection.
Hepatitis B virus: In the United States,
15,000 pregnant women who are
hepatitis B surface an-tigen (HBsAg)positive
deliver annua-lly. 6 Universal
screening of pregnant wo-men for
HBsAg is now performed to reduce per
inata transmission of hepatitis B virus.
The risk of hepatitis B virus transmission
to the fetus is proportional to maternal
hepatitis B virus DNA, as reflected in
hepatitis B antigen (HBeAg) and
antibody (HBeAb) status. The risk of
hepatitis B virus vertical transmission is
10 percent in mothers with negative
HBeAg and positive HBeAb and 90
percent in those with positive HBeAg. 3,6
The risk of chronic hepatitis B virus infection
in a neonate who does not
receive immunoprophylaxis and
vaccination for hepatitis B virus is 40
percent. Infants of HBsAg-positive
mothers’ should receive hepatitis B
immune globulin immunoprophylaxis at
birth and hepatitis B vaccine at one
week, one month and six months after
birth.
This regimen reduces the incidence of
hepatitis B virus vertical transmission to
zero to 3 percent. In cases of acute
hepatitis B virus infection complicating
pregnancy, the prevalence of neonatal
infection depends on the time during
gestation that maternal infection occurs.
115
Neonatal hepatitis B virus infection is
rare if maternal infection takes place in
the first trimester. The infection occurs
in 6 percent of neonates of women
infected in the second trimester, in 67
percent of those infected in the third
trimester and in virtually all of those
infected in the immediate postpartum
period. 12 Neo-nates of mothers
experiencing acute hepatitis B virus
infection should receive
immunoprophylaxis and vaccination, as
outlined above.
Hepatitis C virus: Chronic hepatitis C
virus infection affects 1.4 percent of the
U.S. population the incidence of
hepatitis C virus in-fection is raising
most rapidly among persons 20 to 45
years of age.
Therefore, an increasing number of
patients with hepatitis C virus infection
are requesting information about vertical
transmission of the virus during
pregnancy.
Patients with risk factors for hepatitis C
virus infection, such as intravenous drug
use or other parenteral exposures, should
undergo screening for hepatitis C virus
infection before pregnancy with second-
or third generation hepatitis C virus
antibody assays to confirm exposure to
the virus.
Women with documented hepatitis C
virus infection who are contemplating
pregnancy should be encouraged to
undergo human immunodeficiency virus
(HIV) testing and repeated quantitative
hepatitis C virus RNA measurements to
determine their probable risk of hepatitis
C virus vertical transmission. exposure,
the risk of hepatitis C virus vertical
transmission is zero to 18 percent.