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Hepatitis-2015 Orlando, USA July 20 - 22 2015

Hepatitis-2015 Orlando, USA July 20 - 22 2015. Vani Malhotra. HEPATITIS B INFECTION DURING PREGNANCY –EXPERIENCE AT TERTIARY CARE CENTRE OF NORTH INDIA. Dr Vani Malhotra MD MICOG Professor Department of Obstetrics and Gynecology PGIMS, Rohtak, India.

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Hepatitis-2015 Orlando, USA July 20 - 22 2015

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  1. Hepatitis-2015Orlando, USAJuly 20 - 22 2015 Vani Malhotra

  2. HEPATITIS B INFECTION DURING PREGNANCY –EXPERIENCE AT TERTIARY CARE CENTRE OF NORTH INDIA Dr Vani Malhotra MD MICOG Professor Department of Obstetrics and Gynecology PGIMS, Rohtak, India

  3. Hepatitis B Virus (HBV) infection is a global problem with nearly 350 million carriers at risk for cirrhosis and hepatocellular carcinoma • 50% carriers have acquired their infection vertically from mothers (MTCT) • 90% of vertically acquired infection become chronic

  4. AASLD • All pregnant women be screened for HBsAg during the first trimester, even if previously vaccinated or tested Lok ASF, McMahon BJ. Chronic Hepatitis B: update 2009. Hepatology 2009; 50: 661-2

  5. AASLD & ACOG– POSITIVE MOTHERS Medical evaluation immediately -duration of disease -extent of liver disease -risk factors for MTCT(HBeAg status & viral load)

  6. VERTICAL TRANSMISSION (MTCT) Transmission of pathogen from mother to child during pregnancy or childbirth or by breastfeeding

  7. ROUTE OF TRANSMISSION

  8. IN UTERO-TRANSMISSION • Main risk factors • Maternal HbeAg positivity • High maternal viral load • History of threatened abortion or preterm labor

  9. NATAL TRANSMISSION • Transfusion of mothers blood to fetus during labor contractions(microtransfusions) • Infection after rupture of membranes • Direct contact of the infants mucosal membranes

  10. POSTNATAL TRANSMISSION • Ingestion of virus or by contact with skin lesions on mothers breast

  11. RISK FACTORS FOR MTCT • High maternal viral load • Positive HBeAg status

  12. ANTIVIRAL DRUGS • Potent antiviral suppression • Safe & well tolerated • Reduces perinatal HBV transmission

  13. problems • Viral drug resistance • Contraindication to breast feeding • Hepatitis flares upon discontinuation

  14. IMMUNOPROPHYLAXIS • Infants born to HBsAg –positive mothers should receive both HBIG and HBV within 12 hours of birth • Next two doses should be given within six months of birth • 90-95% protection

  15. Follow up of infants • HBsAg and anti HBs at 9 months of age • HBsAg negative + anti-HBs>10mIU/ml are disease free • Anti-HBs <10mIU/ml-revaccinated(Immunoprophylaxis failure)

  16. RECOMMENDATIONS FOR BREAST FEEDING • With appropriate immunoprophylaxis, breastfeeding of infants of chronic HBV carriers posos no additional risk of transmission of HBV, however antiviral drugs should be stopped

  17. PRESENT STUDY • Prospective study carried at PGIMS, Rohtak from Jan 2014-Dec 2014 • Women in any trimester of pregnancy were tested for HBsAg using ELISA • Women who tested positive were enrolled for the study & liver function tests, HBeAg, HbeAb, IgM Anti HbC& HBV DNA analysis was done using PCR

  18. contd • Women with abnormal liver function tests, positive HBeAg & HBV DNA more than 1lakh copies/ml were given tablet lamivudine 100 mg to reduce the transmission

  19. AIMS & OBJECTIVES • To investigate the Seroprevalence of hepatitis B surface antigen in pregnant women • Management of chronic HBV infection in pregnant mothers • To prevent Mother to child transmission (MTCT) of HBV

  20. OBSERVATIONS • Total cases included in the present study are 15,000 • Out of these , 52 cases were found to be HBsAg positive • Seroprevalence 0.34 (52/15,000)

  21. AGE GROUP(YEARS)N=52

  22. PARITY(n=52)

  23. RISK FACTORS(n=52)

  24. AREA DISTRIBUTIONN=52

  25. SOCIOECONOMIC STATUSN=52

  26. HUSBAND HBsAg StatusN=52

  27. ACTIVITY OF DISEASE

  28. RISK FACTORS FOR MTCT • 12 (23.07%) patients out of 52 patients were HBsAg positive & their DNA titres were more than 1 lac copies/ml, so tab lamivudine was started

  29. MODE OF DELIEVERYN=52

  30. INDICATION OF LSCSN=6

  31. MATURITYN=52

  32. BIRTH WEIGHT(KG)N=52

  33. All the babies received HBIG & HBV vaccine within 12 hrs of birth • Breast feeding was recommended in all

  34. MORTALITY & MORBIDITY

  35. SUMMARY • 50% patients belong to 20-25 year age group • 34.6% were Para 2 • Tattoing was the risk factor in 42.3% patients • 53.8% patients belong to lower S/E status

  36. SUMMARY • In 23.3% patients, HBeAg positivity & high DNA assay was found and were given Tab Lamivudine • 88.4% delivered vaginally • 51.9% were having birth weight in the range of 2.5-3.0kg • All the babies received HBV vaccine & HBIG within 12 hrs of birth

  37. COMPARISON

  38. CONCLUSION • Universal screening of all pregnant women for HBV infection • Pregnant women found to be HBsAg positive should be investigated for risk factors for MTCT • Maternal high HBV DNA & HBeAg positivity are important risk factors for MTCT

  39. CONCLUSION • In women with these risk factors, use of antiviral drugs should be considered for preventing antenatal transmission • All the babies should receive both HBV vaccine and HBIG within 12 h of birth • Breast feeding of infants is recommended, however , mothers should stop these antiviral drugs to limit the exposure of infants to these drugs

  40. TAKE HOME MESSAGE Appropriate treatment & follow-up to HBV infected mothers and their newborns is critical in preventing HBV MTCT & eradicating HBV infection

  41. THANK YOU

  42. Meet the eminent gathering once again atHepatitis-2016Dubai, UAEOctober 17 - 19, 2016 Hepatitis– 2016 Website: hepatitis.omicsgroup.com

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