Human infection with viral hepatitis occurs in most cases at a young age. That is why the situation when hepatitis B during pregnancy is diagnosed in a woman for the first time, is not uncommon. Of course, the ideal situation is when the test for markers of viral hepatitis occurs at the stage of pregnancy planning. However, in real life, the diagnosis of viral hepatitis is often carried out against the background of a pregnancy. In this situation, the leading obstetrician-gynecologist, infectious disease doctor and a married couple need to discuss the situation together and solve a number of issues.
If hepatitis has been identified even at the stage of family planning, the need for and the urgency of first-line treatment of viral hepatitis is further discussed with specialists. At the same time, one should proceed from the chances of cure, the real possibility of a positive result of treatment during pregnancy. Also it is necessary to correlate all this with the need to delay the pregnancy for a period of time - up to a year after the complete termination of therapy.
Influence of hepatitis on the course of pregnancy
One of the main dangers of hepatitis B during pregnancy is the threat of intrauterine infection of the fetus. Vertical transmission (transmission of the virus from mother to fetus) is possible with different types of hepatitis in the etiology and varies widely. Most often, hepatitis B infection occurs and to a lesser extent C. Infection of the child with viral hepatitis A or E may be possible only theoretically at the time of the birth itself in the presence of a particularly acute form of hepatitis in the mother. If intrauterine infection of the fetus occurred in the early stages of pregnancy, it almost always results in miscarriage. It is impossible to influence this process. So the body "culls" the unviable fetus. When a fetus is infected in later stages of pregnancy, a woman gives birth to a live but infected child, and sometimes already with the consequences of the infection that has been developed. It is estimated that about 10% of newborns born from mothers with hepatitis B carriers can be infected in utero. In the presence of pregnant hepatitis in active form, infected can already be about 90% of newborns. That is why the definition of markers for the reproduction of the virus and its number in the blood (viral load) is so important. This is especially important in the second and third trimester of pregnancy, allowing you to assess the risk of subsequent development of hepatitis in a newborn baby. Most often, infection occurs directly at the time of delivery or in the immediate postpartum period, when the mother's infected blood passes through the birth canal through the birth canal to the skin. Sometimes this happens when the child swallows the blood and amniotic fluid of the mother at the time of delivery.
How to prevent infection of a child
To prevent infection in delivery, an important role is played by the tactics of delivery. Unfortunately, there is still no definitive point of view on the management of births in pregnant women who are infected with hepatitis B. There are data that the probability of infection of a child decreases during the planned cesarean section. However, this fact is not a universally accepted point of view. Despite the lack of clear indications of the tactics of labor in women infected with hepatitis, delivery by caesarean section is recommended only at a high level of viral load. It is also necessary when a woman simultaneously infects several hepatitis viruses. Since during pregnancy, hepatitis B can be prevented by vaccination and the planned administration of immunoglobulin, the management of labor in a woman with viral hepatitis is defined as in an uninfected mother in childbirth. Absence of an absolute possibility of protecting a child from infection with hepatitis during childbirth makes postnatal prophylaxis paramount. To prevent the development of hepatitis in newborns, vaccination is being done, creating a real opportunity to prevent infection with both the hepatitis B virus and other species. Children from risk groups are vaccinated simultaneously, that is, they are injected with gamma globulin in combination with vaccination against hepatitis B virus. Passive immunization with hyperimmune anti-globulin is carried out in the delivery room. Vaccination against hepatitis is carried out on the first day after birth and after one and six months, which gives a protective level of antibodies in 95% of newborns.
To solve the problem of possible infection of a child from a mother who has had hepatitis during gestation, it is recommended to conduct a laboratory blood test for the presence of viral antibodies in it. If the antibodies in a newborn are identified in the first three months of life, this indicates intrauterine infection. The treatment of the results of a child's test for the hepatitis virus should be carried out with extreme caution, since often a number of maternal antibodies can be detected up to 15-18 months. This creates a false picture of the child's condition and leads to unreasonable measures to cure him.
Can I pass the infection with breastfeeding?
The possibility of breastfeeding depends on the etiology of viral hepatitis. It is believed that the benefit of breastfeeding in any case is much higher than the insignificant risk of transmission of the virus to the child. Of course, the decision about whether to feed or not to breast-feed the baby is taken only by the mother. Additional risk factors are multiple cracks around the nipples or aphthous changes in the oral cavity of the newborn. Children who are born from a mother, carriers of hepatitis B, can be nurtured naturally if they are vaccinated against the virus in time. In any case, breast-feeding with the presence of a hepatitis virus in a woman is possible only with strict observance of all hygienic rules and the absence of acute intoxication in the mother.