Question

How will you manage an HBsAg positive woman with 8 weeks pregnancy?

Hint:

Administering hepatitis B vaccine and immunoglobulin to the newborn within 12 hours of birth, along with antiviral therapy for the mother, can effectively prevent vertical transmission of hepatitis B.

Answer 1

Step 1: Management of an HBsAg Positive Woman in Pregnancy.
The management of a pregnant woman who is HBsAg positive (indicating chronic hepatitis B infection) involves multiple steps to protect the health of both the mother and the fetus, as well as to reduce the risk of vertical transmission (mother-to-child transmission) of hepatitis B. Key aspects of management include:
(1) Assess the Hepatitis B Viral Load:
- Measure the HBV DNA level to assess the degree of viral replication. High viral loads may require antiviral treatment to reduce the risk of vertical transmission.
(2) Screen for Liver Function and Co-Infections:
- Monitor liver function tests (LFTs), including AST, ALT, bilirubin, and albumin, to assess liver function and potential damage.
- Test for hepatitis D and HIV, as co-infections can complicate the course of hepatitis B.
(3) Administration of Antiviral Therapy:
- In cases of high viral load (HBV DNA>200,000 IU/ml), oral antiviral agents such as tenofovir or lamivudine are recommended. These agents are considered safe during pregnancy and can significantly reduce the risk of vertical transmission.
- Initiate therapy ideally during the third trimester (usually from 28 weeks of pregnancy) to prevent neonatal infection.
(4) Immunization of the Newborn:
- The infant should receive the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) within 12 hours of birth, even if the mother is on antiviral therapy. This combined approach can prevent neonatal hepatitis B infection.
(5) Monitoring for Hepatitis Flare:
- Monitor for signs of hepatic flare during pregnancy, especially in the third trimester, when there may be an increased risk of liver damage. If flare occurs, additional interventions may be necessary.
(6) Postpartum Care and Continued Monitoring:
- After delivery, continue monitoring the mother’s liver function and HBV DNA levels. Long-term antiviral therapy may be required if the mother has ongoing hepatitis B infection.
- Ensure that the newborn receives scheduled immunizations as per national guidelines to prevent the infection from reoccurring.