Unfortunately, many women learn about viral hepatitis during pregnancy, because for the first time they undergo a blood test for hepatitis when registering with a antenatal clinic. The statistics of the disease in expectant mothers are completely disappointing; according to doctors, hepatitis viruses are found in every thirtieth woman. But is it possible to carry a healthy child with hepatitis? And is it possible to give birth with a diagnosis of hepatitis? This material contains all known information about viral hepatitis and its characteristics during pregnancy, popular methods of treating the disease and possible complications.

Hepatitis A during pregnancy

Hepatitis A is considered a “childhood” disease; adults suffer from this disease extremely rarely. Nevertheless, among adults, it is pregnant women who most often encounter Botkin's disease. This is due to the muted functioning of the immune system of expectant mothers and susceptibility to a variety of viruses.

Routes of infection

You can become infected during pregnancy without following:

• simple personal hygiene measures - do not wash your hands after visiting public places;
• food hygiene - do not wash vegetables and fruits, do not process them enough if thermal cooking is necessary;
• purity of drinking water;
• order in the home, allowing for unsanitary conditions;
• and also allowing communication with a person who is a carrier of hepatitis A.

Symptoms

Symptoms in pregnant women appear in three stages:

1. The first symptoms that appear after an incubation period, the duration of which ranges from 7 to 50 days:

• weakness, constant malaise;
• gradual increase in body temperature;
• increasing nausea leading to vomiting;
• fever, chills;
• complete lack of appetite;
• and itchy skin.

1. Main symptoms:

• improvement of general well-being;
• yellowing of the skin, sclera of the eyes, mucous membranes;
• lightening of stool and significant darkening of urine.

This period lasts up to two weeks.

1. Recovery or complications, during which the condition either significantly improves or no improvement is observed and the patient requires urgent hospitalization.

Complications

The disease usually does not have a particular negative effect on the fetus; particularly dangerous complications for the expectant mother are also extremely rare. However, in order to prevent the development of these rare complications, an ill pregnant woman will need to spend her illness in a hospital hospital under the supervision of medical staff.

Treatment

Hepatitis A during pregnancy is treated with a special daily regimen and diet. And also during treatment it is necessary to avoid physical activity and stress, which is not advisable during pregnancy, a priori.

It is important for a sick expectant mother to follow bed rest and all doctor’s instructions.

You must eat a special diet that excludes fatty, fried, salty, sour and canned foods. The menu is made up of neutral, delicate flavors and lean meats, dairy and fermented milk products without fat, vegetables, and cereal porridges.

Sometimes the doctor may prescribe intravenous injections and drips of sorbents to cleanse the body of toxins and a course of vitamin complex for the best recovery.

Prevention

Inflammation of the liver can overtake a woman during any stage of pregnancy, so it is necessary to be extremely careful about your health during this delicate period. Prevention of hepatitis A during pregnancy comes down to preventing infection with the virus, which comes down to:

• to limit contact with sick people;
• to regular hand washing;
• to careful processing of products during cooking;
• to not use dirty and unboiled water from reservoirs for drinking.

The most effective means of prevention is vaccination against hepatitis A.

Hepatitis B during pregnancy

Hepatitis B is a much more serious diagnosis than hepatitis A. The virus has already affected more than 350 million people on our planet. This viral disease does not leave pregnant women alone; medical statistics claim that per thousand pregnant women in Russia there is one case of acute illness and five chronic cases.

Routes of infection

The source, distributor of hepatitis B is its direct carrier, i.e. a person who has a progressive virus in the blood. The causative agent of the disease is contained in fluids produced by the body and is transmitted in the following ways:

• sexual;
• through skin injuries (in case of injections with a non-sterile syringe, cosmetic and medical procedures performed using instruments that come into contact with the hepatitis B virus and have not been properly sterilized);
• contact and household, subject to the presence of injuries on the skin.

But the main threat of the disease that concerns all mothers is that there is a possibility of transmission of the virus to the fetus through the placental barrier or through contact with blood released during the birth process.

Symptoms

Hepatitis B may not show symptoms for quite a long time and during this entire period there will not even be any suspicion of the presence of the disease at the moment. However, during pregnancy, hepatitis B can manifest itself through:

• weaknesses;
• increased body temperature;
• lack of appetite;
• pain in the abdomen;
• joint pain in the arms and legs;
• jaundice with yellowing of the skin and changes in the color of urine and feces;
• On palpation, an enlarged liver can be detected.

How to detect hepatitis B during pregnancy?

To find out about the presence of the hepatitis B virus in the blood, a pregnant woman should contact a gynecologist with a request to undergo a similar diagnosis, but when registering, the diagnosis of viral hepatitis is often included in standard examinations.

If the result of a specific blood test is positive, the doctor will order a repeat test, since there is a possibility of a false positive response. If a repeat test has the same result, the expectant mother will be prescribed maintenance therapy, and the husband and close relatives will be offered a similar diagnosis, because circulation of the virus within the family is extremely likely.

After giving birth, the mother’s treatment will continue at a more intensive pace, and the newborn must be given antibodies against this type of liver inflammation on the first day, while still in the maternity hospital.

Features of the flow

Acute hepatitis B during pregnancy, against the background of a weakened immune system, can develop very quickly, almost at lightning speed, severely affecting the liver and affecting the functioning of other organs, especially often when an infection occurs during the current period of pregnancy.

Chronic hepatitis B worsens very rarely during the current pregnancy. But if a woman planning a pregnancy has developed complications of liver inflammation, then ovulation, as a rule, is not able to occur, so pregnancy with such a diagnosis may not occur at all. And when fertilization of the egg does occur, the pregnancy, unfortunately, is recommended to be terminated at an early stage due to the inability to carry it to term and the extremely high probability of congenital pathologies in the child.

However, it is important to understand that the very fact of the presence of the hepatitis B virus in a mother does not yet provoke any congenital pathologies and defects in her child, but it is the complications of hepatitis that are scary in this regard, which can not only affect the child’s health, but also call into question his life in general. However, the risk of premature birth in a mother with liver inflammation triples.

What is the risk of infection for a child?

Infection of a child most often occurs from contact with the mother's blood or vaginal secretions, which is likely during its passage through the birth canal.

In 5% of cases, infection of a child can occur through breast milk or the placenta.

If a baby is given the vaccine during the first 12 hours of life, this will ensure complete protection against the virus, and in most children infected from birth, hepatitis B occurs in a chronic form. If vaccination is timely, breastfeeding is not contraindicated by doctors.

How and where to give birth with hepatitis B

With a confirmed diagnosis, gynecologists will offer to give birth to a child in a regular maternity hospital on the observation floor. Childbirth, in order to avoid infection of the child, is carried out by caesarean section.

Prevention

The main preventive measure for all segments of the population, including women planning pregnancy, is.

It is also important during pregnancy:

• avoid contact with patients with this disease;
• use only sterile instruments for medical and cosmetic procedures, regularly check sterility or the availability of a sterilizer in beauty salons and medical institutions;
• do not provide first aid, if necessary, without gloves;
• and also not to have new sexual relations with either the expectant mother or her regular partner.

Hepatitis D during pregnancy

Hepatitis D during pregnancy is one of the complications of existing hepatitis B. The virus that causes the disease is transmitted through the blood. Hepatitis Delta is not an independent disease; its development requires a type B virus in the blood.

How is it transmitted?

A pregnant woman with hepatitis B can become infected with hepatitis D:

• in direct contact with infected blood;
• when piercing or during tattooing with non-sterile instruments;
• during blood transfusion;
• sexually.

Hepatitis D can be passed from mother to child during childbirth.

Symptoms

After the incubation period, which ranges from 20 to 180 days, the expectant mother may experience:

• joint pain;
• yellowing of the whites of the eyes, mucous membranes and skin;
• itchy skin and rash resembling an allergy;
• darkening of urine and lightening of stool;
• an admixture of blood may appear in the stool;
• causeless occurrence of bruises and bruises on the skin.

Complications

As you know, it is not so much viral hepatitis itself that harms a person, but rather its complications. For example, hepatitis D can lead to:

• to disruption of brain function;
• to impaired coordination in space;
• to sepsis;
• to premature birth;
• to a miscarriage.

The hepatitis D virus does not cause congenital pathologies or structural abnormalities.

Treatment

If your health worsens due to existing type B liver inflammation, you should immediately consult a doctor.

If hepatitis D is confirmed, the expectant mother is advised to be hospitalized, where symptomatic treatment is prescribed to improve overall well-being, as well as cleanse the body of toxins.

Treatment of hepatitis D in pregnant women is purely individual for each case of the disease.

Prevention

To prevent a hepatitis-positive mother from also getting the Delta virus, she must:

• lead a socially correct lifestyle;
• not have new sexual contacts (this also applies to the pregnant woman’s regular partner);
• and also use only sterile instruments for cosmetic and medical procedures.

It is equally important to warn everyone in contact about your diagnosis in order to prevent further spread of the virus.

Hepatitis C during pregnancy

Hepatitis C, like B, is most often detected in pregnant women not by symptoms, but during examinations of the expectant mother in preparation for childbirth. During acute hepatitis C, pregnancy is not advisable; in some cases, doctors recommend even terminating it in the early stages, especially when the woman’s life is in danger or the disease is progressing too rapidly.

Therefore, doctors most often deal with pregnancy during chronic hepatitis C.

Chronic hepatitis C does not affect the course of pregnancy and the development of the child, however, in the third trimester, the viral load on the woman’s body increases, which carries the risk of premature birth and deterioration of the mother’s well-being.

Transmission of the virus to a child

During pregnancy, the risk that the virus will pass through the placenta is extremely small and is no more than 5%. In addition, maternal antibodies can prevent hepatitis C in a child; they are found in the blood of children and disappear by the age of three.

Chronic hepatitis C is not an indication for cesarean section, however, often women in labor with a similar diagnosis undergo surgery due to the caution of doctors.

Treatment

In many cases, doctors postpone antiviral therapy, if possible, until the postpartum period, but prescribing symptomatic treatment is quite likely. This is due to the proven negative effect of Ribavirin and Interferon on the fetus in the dosages necessary for the treatment of hepatitis.

Against the background of an increase in estrogen, itching of the skin may increase, which is treated by individual correction of hormonal levels, but this symptom disappears on its own in the first days after birth.

If there is a risk of cholestasis, the pregnant woman needs a course of Ursodeoxycholic acid contained in the following drugs:

• Ursodez;
• Ursofalk;
• Ursodex;
• Ursohol.

Complications

The main complication of the disease in pregnant women is hypertension - dilation of the veins of the esophagus. This leads to bleeding in 25% of cases of the disease in the delicate period. Women are most often affected by the phenomenon in the second and third trimester.

However, if a pregnant woman does not develop cirrhosis or liver failure, then the life and health of her baby is practically not in danger.

The main complications of the disease during pregnancy are considered to be:

• premature birth;
• and cholestasis.

Fetal hypotrophy is diagnosed extremely rarely and can only develop with the onset of serious complications (i.e. liver failure or cirrhosis).

Hepatitis E during pregnancy

The most unfavorable viral hepatitis for pregnant women is E. The virus can provoke epidemics, especially in areas with a subtropical climate. Epidemics in the tropics occur during the rainy season, and in Russia the development of hepatitis E is facilitated by the autumn period.

How is it transmitted?

Hepatitis E, like the type A virus, is transmitted by water or nutrition (through unwashed hands, not washed, suitable for raw consumption, and poorly cooked foods.

The fewest cases of contact-household transmission of the virus have been recorded.

The main difference between viral hepatitis E and the others is that it, like type A, does not have a chronic form.

Some scientists claim that transmission of the virus from mother to child during childbirth is almost 100%. This fact is still being studied and is very controversial in the scientific and medical community, but the likelihood of such transmission cannot be completely denied.

Peculiarities

Women infected after the 24th week of pregnancy are at risk of developing fulminant hepatitis E, which is fatal in 20% of cases due to necrosis of liver tissue. Infection during this period is the most deadly for both the mother and the unborn child.

Symptoms

The incubation period of the virus lasts from 20 to 80 days. The first to appear are diarrhea, nausea, vomiting and pain in the joints and muscles. Later, jaundice appears, with the appearance of which, unlike hepatitis A, the woman’s condition does not improve, and fever.

The fulminant form is similar to the severe course of hepatitis B, with jaundice constantly increasing, the fever becomes debilitating, and symptoms appear.

When a miscarriage occurs, the woman’s condition deteriorates sharply; often, delayed medical care, in this case, leads to her death.

Complications

The main complications of this disease during pregnancy are:

• liver failure;
• hepatic coma;
• heavy bleeding during childbirth, leading to large blood losses;
• miscarriage;
• death of the fetus in the womb;
• death of a newborn.

When infected in the second trimester, the gestation of an absolutely healthy fetus is practically impossible. A child born alive has signs of severe hypoxia and developmental delay. Often such babies are not adapted to life outside the mother’s womb and die before reaching three months.

Treatment

Termination of pregnancy during type E liver inflammation is prohibited, with the exception of short periods when there is no need for instrumental intervention.

The woman is hospitalized in the infectious diseases department, where there is quick access to obstetric care.

There is no antiviral therapy for hepatitis E; treatment, as a rule, consists of relieving symptoms of intoxication and preventing the development of liver failure or combating it if symptoms have already appeared.

Treatment of hepatitis E in pregnant women does not have positive results; as a rule, every fifth woman infected in the second or third trimester dies even with timely treatment, and term birth is often complicated by severe bleeding.

Prevention

Preventing hepatitis E is much easier to follow than treating it. It consists of:

• avoiding communication and any contact with sick people or people who were in the area of ​​the virus outbreak;
• in careful personal hygiene, especially washing hands in clean, running water and soap;
• in careful processing of food products;
• in sufficient heat treatment;
• excluding the use of unboiled water from reservoirs;
• prohibiting a pregnant woman from being near lakes, ponds and other bodies of water with standing water and, moreover, from swimming in them.

Sometimes, when people receive test results, they see that their result is a false positive. Of course, this cannot be known immediately; further research must be carried out. Most often, this error occurs when taking tests for hepatitis C, which is one of the most serious diseases that leads to death.

A little about the disease

Before moving on to why the test result may be false positive, it is necessary to pay a little attention to the disease itself.

Hepatitis C is a very dangerous infectious disease that affects the human liver. And, as you know, if problems with the liver begin, then the whole body will gradually malfunction. From the moment of infection until the first symptoms appear, it can take from one and a half to five months. Everything will depend on the person’s immune system, as well as other existing chronic diseases.

After the virus has become active, two stages of development are distinguished. The first (also called sluggish) is characterized by a slight deterioration of the condition. Thus, weakness and sometimes insomnia appear. At the moment when the virus begins to act more actively, the person’s well-being worsens, the urine becomes darker, and the skin acquires a yellowish tint. And in some cases, the whites of the eyes begin to turn yellow.

One of the features of the disease that makes it even more dangerous is its asymptomatic course.

In most cases, hepatitis C is asymptomatic until cirrhosis of the liver begins. And before this, a slight deterioration in well-being, such as fatigue and change in the color of urine, is attributed by many people to stress, chronic fatigue and poor nutrition. Precisely because in the majority of cases, hepatitis C is asymptomatic, it is very easy to become infected. A person may not even know about the disease and transmit it to another, especially during sexual intercourse.

More than 80 percent of people who have hepatitis C say that they learned about the disease by chance, when at one point they needed to be examined and one of the points was taking tests for blood and hepatitis. About 20-30 percent of patients are cured, but their quality of life is significantly impaired due to liver damage.

Also, approximately the same number of people have suffered an acute form of the disease and can be considered simply carriers of the virus. But the big danger is that the disease becomes chronic, and, despite the cure, they are carriers.

These people have the following symptoms:

• Frequent nausea.
• Painful sensations in the abdominal area, which can be either periodic or constant.
• Joint pain, which many patients call debilitating.
• Diarrhea that occurs frequently and suddenly.
• Slight yellowing of the skin.

It is believed that it is almost impossible to recognize hepatitis C on your own, since even experienced doctors can make a diagnosis based only on the test results obtained.

Methods for diagnosing the disease

Today, there are several methods for diagnosing hepatitis C, the most important of which is the ELISA test.

At the very beginning, if a person is suspected of having hepatitis C, the doctor prescribes an enzyme-linked immunosorbent assay, the results of which are ready literally within a day. This analysis reveals the presence of antibodies in a person’s blood.

It is known that with every disease the human body produces specific antibodies. That is why this type of analysis is the most reliable. True, the presence of antibodies in the body can indicate two things - either the person has already been cured and still has antibodies, or he just got sick and the body is intensively fighting the infection.

But sometimes it is necessary to clarify the result obtained, since not always, based on it, the doctor can make an accurate diagnosis and prescribe treatment.

Thus, the following are additionally assigned:

• A complete blood test that will show not only the level of hemoglobin and white blood cells, but also the level of other important components in the blood.
• PCR analysis, that is, detection of the presence of pathogen DNA in the blood.
• Ultrasound of the liver, during which changes can be noticed.
• Ultrasound of the abdominal organs.

These tests are prescribed not only because doctors sometimes doubt the diagnosis, but also because there are cases when the test turns out to be false positive. And to refute it, additional research needs to be done.

False positive test result

Sometimes the result of the analysis may be false positive. In most cases, this is not a mistake of medical personnel, but the impact of external and internal factors on the human body.

So, there are several reasons why the analysis may be false positive:

1. Autoimmune diseases, during which the body literally fights itself.
2. The presence of tumors in the body, which can be either benign (that is, not dangerous) or malignant (which must be treated immediately)
3. The presence of infection in the body, namely Atkoy, the area of ​​​​influence and damage of which is very similar to hepatitis.
4. Vaccination, for example, against influenza.
5. Conducting interferon alpha therapy.
6. Some features of the body, such as a constant increase in the level of bilirubin in the blood.

More information about hepatitis C can be found in the video.

Sometimes pregnant women get a false positive test result. It is believed that during pregnancy the body undergoes changes. And in the presence of a Rh conflict, when the mother’s body simply rejects the baby, the likelihood of receiving a false-positive test increases. The immune system begins to work differently, and such a failure may occur.

People who take immunosuppressants can also get a false positive test result.

In order to accurately make a diagnosis, as well as refute the test results, it is necessary to conduct additional research.

Human factor

It is believed that sometimes the cause of a false positive test result is human error. This may include:

• Inexperience of the doctor who performed the analysis.
• Accidental replacement of test tubes.
• A mistake by a laboratory technician who conducts research, for example, is simply a typo in the result itself.
• Improper preparation of blood samples for testing.
• Exposure of samples to elevated temperatures.

It is believed that this reason is the worst, since due to the human factor and low qualifications, a person may suffer.

False positive result in pregnant women

Causes of false positive test results in pregnant women

At the very beginning of pregnancy, each woman receives from her doctor a referral for many tests, among which there is a test for hepatitis C. And, even knowing for sure that she does not have such a disease, the woman has to take it.

And, unfortunately, some women receive positive test results. There is no need to panic right away, as this can happen during pregnancy. And the reason will not be the actual presence of the virus in the body, but simply its reaction to pregnancy.

At the moment of bearing a baby, a woman’s body undergoes enormous changes, and a malfunction can happen anywhere.

False-positive test results in pregnant women are associated with:

• The process of gestation itself, during which the production of specific proteins occurs.
• Changes in hormonal levels, which are simply inevitable, since in order to bear a baby it is necessary that the hormones (some) be slightly elevated.
• A change in blood composition that occurs due to the need to give nutrients and vitamins to the baby. And besides, during pregnancy, women try to eat healthy and eat a lot of fruits, vegetables, and meat, which change the composition of the blood.
• Increased levels of cytokines in the blood, which are involved in intercellular and intersystem regulation in the body, and contribute to their better survival, growth, etc.
• The presence of other infections in the body. Sometimes a woman’s immunity decreases while carrying a baby, and she becomes very susceptible to viruses. So, if a woman has a runny nose or sore throat, and she takes a test for hepatitis, then the likelihood of getting a false positive result increases.

Many doctors do not inform their patients about receiving false positive results, but simply send them for additional tests. This is done solely out of good intentions, since any stress, especially in the early stages, can lead to termination of pregnancy.

The blood of pregnant women is considered “very complex”, since it increases in absolutely all indicators, and in order to get a reliable result, the specialist conducting the analysis must be very experienced.

How to avoid false positive results

Also, it is better to donate blood when there is no deterioration in health, for example, a cold. Because, as mentioned above, it affects the result.

To protect yourself from receiving a false positive result, you can simultaneously take a test to detect DNA and RNA of the virus in your blood. This analysis is more reliable, since it is very difficult to make a mistake if there are no components of the virus in the blood. True, such tests are not carried out in a simple clinic; you need to go to a paid one.

Also, if you have chronic diseases, you must inform your doctor about this, since taking certain medications may affect the results of the analysis.

A false positive test for hepatitis C is not common, since such an error often costs doctors their jobs and people’s nerves. Receiving a false-positive test should not come as a shock, since in order to make a diagnosis and find out the cause, you need to undergo several additional tests. And only after this will they draw conclusions whether this was a false positive result, or whether hepatitis C still exists.

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2011-06-13T02:55:03+04:00

Hepatitis C during pregnancy

Every expectant mother wants to have a healthy and strong baby. Therefore, many women undergo various examinations even before conception to eliminate the risk of transmitting any disease to the child during pregnancy or childbirth. One of the dangerous diseases that worries women is viral hepatitis C. Indeed, pregnancy and hepatitis C an extremely undesirable combination, since there is a high probability of infection of the fetus. Despite the fact that the hepatitis virus does not cause birth defects, some children are born with signs of inflammation in the liver. Doctors call hepatitis C the “soft killer” because acute symptoms of the disease may be absent or mild. But after some time, hepatitis becomes chronic, and then cirrhosis and even cancer develop.

Pregnancy and hepatitis C: features

When a woman becomes infected with hepatitis C during pregnancy, she may also not show signs of inflammation, or due to the mild severity of the manifestations, she may not pay attention to them. However, the virus gradually destroys liver cells, which sometimes leads to the development of intoxication and can cause miscarriage. According to various medical data, pregnancy can provoke an exacerbation of hepatitis C. If an exacerbation does not occur, the disease itself, as a rule, does not have a negative effect on the condition of the mother and fetus. Although, with a long course (more than 3-5 years), cases of miscarriage become more frequent in pregnant women. More than 90% of acute hepatitis C becomes chronic. The chronic form of hepatitis develops 6 months after infection and is characterized by periods of exacerbations and remissions (asymptomatic).

Intrauterine hepatitis infection

The hepatitis C virus is rarely transmitted to a child during childbirth; infection mainly occurs during pregnancy. In this case, the disease can cause delayed maturation of the placenta with a lack of oxygen in the fetus. It is worth noting that children born from mothers with hepatitis often have antibodies to the virus in their blood, which may disappear by the middle of the child’s second year of life. However, if they are detected after 18 months from birth, then this indicates infection. Hepatitis C in a baby will also be indicated by: increased liver enzymes, which indirectly reflect inflammation of the liver tissue; twice positive test for RNA virus (performed at the age of 3 and 6 months). The same genotype of the hepatitis C virus in mother and child can serve as confirmation of perinatal infection.

Treatment of hepatitis during pregnancy

Therapy of the disease should be carried out with the participation of several specialists: a hepatologist, an obstetrician-gynecologist and an immunologist. Treatment of viral hepatitis C in pregnant women is prescribed only when there are pronounced signs of the disease, since the height of the disease is accompanied by severe intoxication, which can lead to the loss of the baby. In other cases, doctors adhere to the tactics of monitoring the condition of the mother and child. The point is also that the main specific antiviral drugs that are prescribed for hepatitis C are contraindicated during pregnancy due to side effects, in particular due to the high risk of developing congenital deformities in the fetus. Some doctors also refuse to use parenteral interferons, since due to numerous side effects they are contraindicated for use during pregnancy.

Pregnancy and hepatitis C: modern therapy

Russian scientists have developed a drug that has successfully passed many years of clinical trials, has extensive experience of successful use in the combined treatment of hepatitis C, and is used from 14 weeks of pregnancy. The drug belongs to the class of recombinant interferons with an active protein compound in its composition - alpha-2b interferon, which has pronounced antiviral and immunomodulatory properties. VIFERON® also contains a complex of natural antioxidants that enhance the antiviral effect of the main active ingredient. During pregnancy, such women with hepatitis are also prescribed hepatoprotectors (medicines to maintain liver function) and a strict diet, which prohibits eating fried, spicy, fatty and salty foods, as well as consuming strong and invigorating drinks.

IMPORTANT

Many women with hepatitis C are afraid of becoming pregnant and having children. It is worth noting that the disease is not a contraindication to normal conception, gestation and birth of a baby. Thanks to modern comprehensive methods of prevention and treatment of hepatitis, including the use of Viferon, the risk of developing an acute process and complications is sharply reduced. The main thing is to closely monitor your health during pregnancy and undergo examination (routine or as prescribed by a doctor) for the presence of antibodies to the virus and viral markers in the blood serum. This will make it possible to identify the activity of the hepatitis C virus, prescribe adequate therapy, which will help a woman more easily cope with the disease during pregnancy and prevent the possibility of infecting the child.

Based on materials:

1. “Viferon against HCV”, (experience of use), V.A. Maksimov, V.A. Neronov, S.N. Zelentsov, S.D. Karabaev, A.L. Chernyshev.

2. Chronic viral hepatitis in children.” Methodological recommendations/Voronezh. GMA, comp. S.P. Kokoreva, E.A. Zhuravets, L.M. Ilunina.

Today, many women are carriers of viral hepatitis C, but I don’t know why. They often learn of their diagnosis while pregnant. In most cases, this information is shocking and frightening for a pregnant woman. The question arises about the possibility of bearing and giving birth to a healthy child.

What is hepatitis

Hepatitis is an inflammatory disease of the liver, which is often caused by viral pathogens. In addition to viral forms of the disease, there is also a group that is caused by the toxic effects of substances. These include autoimmune hepatitis and radiation.

Hepatitis C belongs to a viral group of diseases. Promotes the development of malignant neoplasms.

Today this species is the most dangerous. The characteristic latent form of the disease often leads to serious complications. Cause disability or death.

How can a pregnant woman become infected with hepatitis C?

Viral hepatitis C is widespread throughout the world. It is considered a disease of the young. It is most often diagnosed in people under the age of 30.

Main routes of infection:

1. Applying a tattoo.
2. Piercing the piercing.
3. Injection with a common needle (including drug addiction).
4. Sharing personal hygiene products (toothbrushes, razors, manicure tools).
5. During operations.
6. During dental treatment.
7. Unprotected sexual contact with an infected person.

Thus, the main route of infection with hepatitis C is blood and sexual fluids.

The disease is not transmitted by airborne droplets, through hugs and handshakes, or when using shared utensils.

It is possible to live together with a sick person, provided all precautions are taken.

Pregnancy can provoke the development of hepatitis C if the woman was previously a carrier of it. This is due to a decrease in the efficiency of the immune system.

Is the disease transmitted to the fetus?

Every woman who has been diagnosed with hepatitis C during pregnancy worries about the possibility of infection and the consequences for the child.

There is a chance of infection, but it is quite small.

Doctors say that the probability of intrauterine infection of a child does not exceed 5%.

It is also believed that the possibility of infection during childbirth is higher than during pregnancy. Since the risk of the mother’s blood entering the child’s body increases.

Methods of transmission of the virus from mother to child:

• during childbirth - when maternal blood enters the child’s body;
• a newborn baby can get the virus from the mother while caring for him - umbilical cord treatment. However, if precautions are taken, the likelihood of such infection is low;
• during breastfeeding - if nipple trauma occurs (cracks or sores).

After birth, the baby is monitored and his blood is regularly checked for the presence of antibodies. Tests are taken at the ages of 1, 3 and 6 months.

If there is no RNA virus in the blood, then the child is healthy.

If the test results are positive, the child will be prescribed appropriate treatment.

Types of diseases and their impact on pregnancy

There are 2 forms of viral hepatitis C:

• Spicy;
• Chronic.

Chronic hepatitis C is a form when a person has been sick for more than 6 months.

Often pregnant women find themselves with this type of hepatitis.

It should be noted that the chronic form is practically safe for the fetus. It is not the cause of congenital pathologies of child development and pregnancy complications.

Chronic hepatitis C does not have a negative impact on the possibility of conceiving a child.

Along with this, this form often causes premature birth and stunted growth of the child. This is due to the presence of liver cirrhosis in the mother.

In case of a positive result, she will be given the necessary consultation and the tactics of behavior in the current situation will be explained.

If the result of the analysis is questionable, then it is possible to conduct an additional study called. It will allow you to accurately determine the presence of the disease in a woman.

Treatment of hepatitis C in pregnant women

Medications used to treat hepatitis C are contraindicated during pregnancy. This is due to the fact that they provoke the development of intrauterine pathologies of fetal development.

In most cases, all treatment is stopped or not even started at the time of pregnancy.

In some cases, drug therapy is necessary.

Typically, drugs are prescribed in cases of bile stagnation or if stones have been detected.

It is necessary to understand that even if there is a need to prescribe medications, they will be selected in such a way as to cause the least harm to the unborn child.

If a pregnant woman has an acute form of hepatitis C, then all treatment will be aimed at maintaining the pregnancy. In this case, the risk of miscarriage increases significantly.

How to give birth with hepatitis C

To date, there is no single medical opinion on the method of delivery for a pregnant woman infected with viral hepatitis C.

There is an opinion that the risk of infection of the child during childbirth is significantly reduced if surgery is performed.

In Russia, women infected with hepatitis C have the right to choose the method of delivery. Doctors are obliged to inform the woman in labor about possible risks and complications.

Also, a guideline for choosing a birth option is the woman’s viral load level.

If it is high enough, then preference should be given to a caesarean section.

Viral hepatitis C and pregnancy are compatible. This disease is not a contraindication to conception and birth of a child.

The question “Is it possible to give birth with hepatitis C?” has a clear answer “Yes”. Even if the mother has the disease, the chance of giving birth to a healthy child is quite high.

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Video: hepatitis C and pregnancy

Hepatitis C is a viral anthroponotic infection with predominant liver damage, prone to long-term chronic asymptomatic course, and outcome in liver cirrhosis and primary hepatocellular carcinoma. Hepatitis with a blood-contact mechanism of pathogen transmission.

SYNONYMS

Hepatitis C; viral hepatitis non-A, non-B with parenteral transmission mechanism.
ICD-10 CODE
B17.1 Acute hepatitis C.
B18.2 Chronic viral hepatitis C.

EPIDEMIOLOGY

The source and reservoir of hepatitis C is a patient with acute or chronic infection. HCV RNA can be detected in the blood very early, already 1–2 weeks after infection. From an epidemiological perspective, the most unfavorable are the inapparent (subclinical) forms of hepatitis C, which predominate in this disease. The prevalence of infection to a certain extent characterizes the infection of donors: in the world it ranges from 0.5 to 7%, in Russia it is 1.2–4.8%.

Hepatitis C, like hepatitis B, has a blood-borne route of infection; they have the same transmission factors and high-risk groups for infection. The infectious dose of HCV is several times higher than that of HBV: the probability of contracting hepatitis C when injected with a needle contaminated with the pathogen reaches 3–10%. Contact of infected blood with intact mucous membranes and skin does not lead to infection. Vertical transmission of HCV is a rare phenomenon, and some authors deny it. The likelihood of domestic and professional infection is low, but the incidence of hepatitis C in medical workers is still higher (1.5–2%) than in the general population (0.3–0.4%).

The leading role in risk groups belongs to drug users (drug addicts' hepatitis). The role of sexual and intrafamily contacts in hepatitis C infection is insignificant (about 3%). For comparison: the risk of sexual transmission of HBV is 30%, HIV is 10–15%. In the case of sexually transmitted infection, transmission of the pathogen most often occurs from man to woman.

Hepatitis C is found everywhere. It is believed that at least 500 million people in the world are infected with HCV, i.e. There are significantly more HCV infected people than HBSAg carriers.

7 genotypes and more than 100 subgenotypes of the hepatitis C virus have been identified. In Russia, one genotype dominates, and three genotypes occur.

The increase in incidence in the world and in the country is partly of a registration nature (improved diagnosis throughout the country with the beginning of mandatory registration of hepatitis C in 1994), but there is also a true increase in the number of patients.

CLASSIFICATION

There are acute and chronic forms (phase) of hepatitis C. The latter is usually divided into subclinical and manifest (reactivation phase).

ETIOLOGY (CAUSES) OF HEPATITIS C

The causative agent of hepatitis C (HCV) is an RNA virus. It is characterized by extreme variability, which hinders the creation of a vaccine. The virus contains structural proteins: core (heart-shaped), E1 and E2 and non-structural proteins (NS2, NS3, NS4A, NS4B, NS5A and NS5B), the detection of which is used to verify the diagnosis of hepatitis C, incl. its forms (phases).

PATHOGENESIS

Having entered the human body through the entrance gate, the pathogen penetrates hepatocytes, where it replicates. The direct cytopathic effect of HCV has been proven, but the hepatitis C virus has weak immunogenicity, so elimination of the pathogen does not occur (just like HAV, which has a direct cytopathic effect). Antibody formation in hepatitis C is imperfect, which also prevents the neutralization of the virus. Spontaneous recovery is rare. 80% or more of those infected with HCV develop chronic hepatitis with long-term persistence of the pathogen in the body, the mechanism of which is different from the persistence of HBV. With hepatitis C, there are no integrative forms due to the special structure of the virus (it has neither template nor intermediate DNA). The persistence of the pathogen in hepatitis C is explained by the fact that the rate of mutation of viruses significantly exceeds the rate of their replication. The resulting antibodies are highly specific and cannot neutralize rapidly mutating viruses (“immune escape”). Long-term persistence is also facilitated by the proven ability of HCV to replicate outside the liver: in the cells of the bone marrow, spleen, lymph nodes, and peripheral blood.

Hepatitis C is characterized by the inclusion of autoimmune mechanisms, resulting in numerous extrahepatic manifestations of chronic hepatitis C.

What distinguishes hepatitis C from other viral hepatitis is its torpid subclinical or asymptomatic course and, at the same time, its asymptomatic but steady progression of the pathological process in the liver and other organs, especially in older people (50 years or more) suffering from concomitant pathology, alcoholism, drug addiction, protein-energy insufficiency, etc.

Most researchers believe that the genotype of the virus does not affect the progression of the disease and its rate. An immunogenetic predisposition to hepatitis C is possible.

Chronic hepatitis C usually occurs with minimal or weak activity of the pathological process and unexpressed or moderate fibrosis (according to the results of intravital liver biopsies), but often the rate of fibrosis is quite high.

PATHOGENESIS OF GESTATION COMPLICATIONS

The pathogenesis, as well as the range of complications of gestation, is the same as with other hepatitis, but they are very rare.

CLINICAL PICTURE (SYMPTOMS) OF HEPATITIS C IN PREGNANT WOMEN

In most patients, acute hepatitis C occurs subclinically and, as a rule, is not recognized. When examining the focus of infection in patients without clinical manifestations, a moderate increase in the activity of ALT, antibodies to the causative agent of hepatitis C (anti-HCV) and/or RNA virus in PCR is determined. Manifest forms are usually mild, without jaundice. The duration of the incubation period is therefore very difficult to determine.

The prodromal period is similar to that of hepatitis A and B; its duration is difficult to estimate. During the peak period, some patients develop mild, rapidly passing jaundice; heaviness in the epigastric region and right hypochondrium is possible. The liver is slightly or moderately enlarged.

Seroconversion (appearance of anti-HCV) occurs 6–8 weeks after infection. HCV RNA can be detected from the blood of an infected person within 1–2 weeks.

Chronic hepatitis C is almost always subclinical or asymptomatic, but viremia persists, often with a small viral load, but high replicative activity of the pathogen is also possible. In these cases, the viral load can be high. As the disease progresses, a periodic wave-like increase in ALT activity (3–5 times higher than normal) is noted when patients feel well. In this case, anti-HCV is determined in the blood. It is also possible to isolate HCV RNA, but not consistently and in low concentrations.

The duration of chronic hepatitis C can vary, most often it is 15–20 years, but often longer. In some cases, the duration of the disease is noticeably reduced with superinfection, and most of all with mixed HCV+HIV infection.

The reactivation phase of hepatitis C is manifested by the manifestation of symptoms of a chronic disease with subsequent outcome in liver cirrhosis and primary hepatocellular cancer against the background of progressive liver failure, hepatomegaly, often with splenomegaly. At the same time, biochemical signs of liver damage worsen (increased ALT, GGT, dysproteinemia, etc.).

Chronic hepatitis C is characterized by extrahepatic symptoms (vasculitis, glomerulonephritis, cryoglobulinemia, thyroiditis, neuromuscular disorders, articular syndrome, aplastic anemia and other autoimmune disorders). Sometimes it is precisely these symptoms that become the first sign of chronic hepatitis C, and patients are first diagnosed correctly. Thus, with autoimmune symptoms, mandatory examination of patients for hepatitis C using molecular biological and immunoserological methods is necessary.

The outcomes of chronic hepatitis C are cirrhosis and liver cancer with corresponding symptoms. It is important that the risk of liver cancer with hepatitis C is 3 times higher than with hepatitis B. It develops in 30–40% of patients with cirrhosis.

Primary hepatoma in hepatitis C progresses quickly (cachexia, liver failure, and gastrointestinal manifestations are noted).

Complications of gestation

In most cases, hepatitis C occurs as in non-pregnant women. Complications are very rare. Management of a pregnant woman with hepatitis C includes careful observation to timely determine the possible threat of miscarriage and fetal hypoxia. Some pregnant women occasionally experience clinical and biochemical signs of cholestasis (skin itching, increased activity of alkaline phosphatase, GGT, etc.); the development of gestosis is possible, the frequency of which usually increases with extragenital diseases.

DIAGNOSIS OF HEPATITIS C IN PREGNANCY

Recognizing hepatitis C is a clinically difficult task due to the peculiarities of the course and mild or absent symptoms for a long time.

Anamnesis

A well-conducted epidemiological history is important, during which it is possible to determine the patient’s predisposition to a group at high risk of contracting hepatitis C (as with hepatitis B). When collecting anamnesis, you should pay special attention to episodes of unclear ailments in the past and signs characteristic of the prodromal period of viral hepatitis. A history of jaundice, even mild, obliges the patient, including a pregnant woman, to be examined for hepatitis, including hepatitis C.

Laboratory research

Of primary importance is the diagnosis of hepatitis using biochemical methods, as with other etiological forms of viral hepatitis. The results of detection of hepatitis C markers are of decisive and verifying importance. Anti-HCV is determined in the blood using the ELISA method, and a reference test is performed. The detection of HCV RNA in the blood or liver tissue using the PCR method has the greatest diagnostic value, since it indicates not only the etiological diagnosis, but also the ongoing replication of the virus. The presence of anti-HCV is important for the verification of hepatitis C; simultaneous determination of antibodies to non-structural proteins (especially anti-HCV NS4) indicates chronic hepatitis C. A high viral load when quantifying HCV RNA may correlate with high activity of the pathological process and accelerated rates of cirrhosis formation liver; in addition, this indicator is used to judge the effectiveness of antiviral therapy.

In chronic hepatitis C, an important place in the diagnosis and determination of prognosis is occupied by intravital liver biopsy with assessment of the activity of the pathological process (minimal, low, moderate, severe) and the degree of development of fibrosis.

Pregnant women are required (as with hepatitis B) to be screened for hepatitis C.

Differential diagnosis

Differential diagnosis is carried out as for other viral hepatitis.

Indications for consultation with other specialists

Pregnant women with hepatitis C are monitored by an infectious disease specialist and an obstetrician-gynecologist. In case of autoimmune signs of chronic hepatitis C, the help of specialists in the relevant field may be required, for drug-addicted women - a narcologist, a psychologist.

An example of a diagnosis formulation

Pregnancy 17–18 weeks. Chronic hepatitis C, low degree of activity of the pathological process, weak fibrosis.

TREATMENT OF HEPATITIS C DURING PREGNANCY

For manifest forms of hepatitis C (acute and chronic), therapy is carried out as for hepatitis B, using methods of drug pathogenetic and symptomatic therapy.

Drug treatment

Outside of pregnancy, the basis of therapy is interferon alpha antiviral drugs (with a 6-month course for acute hepatitis and a 6-12-month course for chronic hepatitis).

If HCV RNA continues to circulate after 3 months from the start of interferon therapy (or if hepatitis C relapses after completing a course of interferon alfa), treatment of patients is supplemented with ribavirin.

During pregnancy, etiotropic antiviral therapy for hepatitis C is contraindicated; if necessary, pathogenetic and symptomatic treatment of patients is carried out.

Prevention and prediction of gestational complications

Prevention and prediction of gestational complications is carried out according to the general rules adopted in obstetrics.

Features of treatment of complications of gestation

There are no particularities in the treatment of complications of gestation, including in each trimester, during childbirth and the postpartum period.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

If autoimmune signs of hepatitis C develop, consultations with specialists of the necessary profile are indicated to coordinate treatment methods with them. If the course of the disease worsens, provide observation by an infectious disease specialist.

INDICATIONS FOR HOSPITALIZATION

In many cases of chronic hepatitis C, it is possible to manage pregnant women on an outpatient basis (with a favorable course of infection and gestation). In the acute phase of hepatitis C in pregnant women, hospitalization in an infectious diseases hospital and observation by an obstetrician-gynecologist are necessary.

ASSESSMENT OF TREATMENT EFFECTIVENESS

With the correct management tactics for pregnant women with hepatitis C, the effectiveness of treatment for possible rare complications is the same as for non-pregnant women.

CHOICE OF DATE AND METHOD OF DELIVERY

All efforts of obstetricians should be aimed at ensuring that patients with hepatitis C give birth on time through the natural birth canal.

INFORMATION FOR THE PATIENT

Vertical transmission of the hepatitis C pathogen to the fetus is possible, but extremely rare. HCV is not transmitted through mother's milk, therefore, there is no need to stop breastfeeding.

Women suffering from chronic hepatitis C who are planning a pregnancy should undergo a full cycle of vaccination against hepatitis B, in order to avoid subsequent mixed infection B + C. The same should be done after delivery (if there was no vaccination against hepatitis B before pregnancy).

The detection of anti-HCV in a newborn for 18 months is not considered a sign of infection (Abs are of maternal origin). Further monitoring of the child involves examining him at 3 and 6 months of life using PCR for the possible detection of HCV RNA, the presence of which (if detected at least 2 times) will indicate infection (if the genotype of the virus is the same in the mother and child).