1. Hepatitis B in pregnancy can impact both mother and child. Vertical transmission from mother to child is a major risk, occurring in 30% of cases without intervention.
2. Diagnosis involves screening all pregnant women for HBsAg. For HBsAg positive mothers, further testing of HBV DNA viral load, HBeAg status, and liver enzymes can assess risk of transmission.
3. Prevention of mother-to-child transmission focuses on antiviral therapy starting at 28 weeks for mothers with high viral load, administration of HBIG and HBV vaccines within 12 hours of birth, and completion of the vaccine series for the infant.
Pregnancy and viral hepatitis by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral infections is not affected by pregnancy.
Jaundice is a characteristic feature of liver disease. The clinical signs and symptoms are indistinguishable between the various forms of viral hepatitis, thus, the differential diagnosis requires serologic testing for a virus-specific diagnosis, [1, 2] and the diagnosis is by biochemical assessment of liver function.
The differential diagnosis includes other forms of viral hepatitis including mononucleosis and Epstein-Barr virus (EBV) infections, autoimmune disease, and widespread systemic infection with liver failure. Patients presenting with jaundice during pregnancy often require a workup to differentiate obstructive gall bladder or bile duct disease, severe preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, low platelet count), or acute fatty liver of pregnancy from viral hepatitis.
The most useful tests to diagnose hepatitis include laboratory evaluation of urine bilirubin and urobilinogen, total and direct serum bilirubin, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), prothrombin time (PT), total protein, albumin, complete blood cell (CBC) count, and in severe cases, serum ammonia.
Pregnancy and viral hepatitis by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral infections is not affected by pregnancy.
Jaundice is a characteristic feature of liver disease. The clinical signs and symptoms are indistinguishable between the various forms of viral hepatitis, thus, the differential diagnosis requires serologic testing for a virus-specific diagnosis, [1, 2] and the diagnosis is by biochemical assessment of liver function.
The differential diagnosis includes other forms of viral hepatitis including mononucleosis and Epstein-Barr virus (EBV) infections, autoimmune disease, and widespread systemic infection with liver failure. Patients presenting with jaundice during pregnancy often require a workup to differentiate obstructive gall bladder or bile duct disease, severe preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, low platelet count), or acute fatty liver of pregnancy from viral hepatitis.
The most useful tests to diagnose hepatitis include laboratory evaluation of urine bilirubin and urobilinogen, total and direct serum bilirubin, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), prothrombin time (PT), total protein, albumin, complete blood cell (CBC) count, and in severe cases, serum ammonia.
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
The physiological changes in the liver during pregnancy
The possibilities of liver diseases
LFT in pregnancy
Intercurrent and pre-existing liver disease: viral hepatitis, autoimmune hepatitis, gall stones
Pregnancy associated liver disease: Hyperemesis Gravidarum, Acute cholestasis of pregnancy, Acute fatty liver of pregnancy, HELLP syndrome
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
The physiological changes in the liver during pregnancy
The possibilities of liver diseases
LFT in pregnancy
Intercurrent and pre-existing liver disease: viral hepatitis, autoimmune hepatitis, gall stones
Pregnancy associated liver disease: Hyperemesis Gravidarum, Acute cholestasis of pregnancy, Acute fatty liver of pregnancy, HELLP syndrome
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
Current managent of hepatitis B - Session 1NimzingLadep
This is the first of 3 sessions in the module covering a comprehensive overview of the management of hepatitis B virus infection. It discusses the introduction, presentation, symptoms and signs, as well as management of acute hepatitis B.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#HEPATITIS MADE EASY#HEPATITS B#HEPATITIS C#
Impact of Hepatitis B Virus (HBV) Vaccination in Childrens Born to HBV Positi...IOSR Journals
Perinatal HBV transmission is common in South East Asia approximately 25- 30% of the carrier
pool. The problem is not only to the mother but also pertains to the offspring, in pregnancy hepatitis; the
immune alterations in pregnancy may modify the dynamics of the disease. The infants of the mothers, who are
carrying both HBsAg and HBeAg, have the highest risk of acquiring the HBV infection by the perinatal route.
The over all risk may vary from one population to another, depending on the prevalence of HBeAg positivity in
the pregnant women. It is reported and estimated that 22,000 pregnant women in the United States get infected
with hepatitis B virus, which necessitated hepatitis B vaccination of the newborn mandatory in the United
States.
This study was aimed to bring about authenticated documentation on impact of preventive measures by
vaccination that are essential features to plan and implement health measures package in a country.
Results: Inspite of neonatal vaccination against hepatitis B given to all 158 children born to their HBsAg
positive mothers, 6.8% (6/87) of these infants reached the status of chronic HBV infection from their infected
mothers after 12 months follow-up.
Conclusion: 6.8% (6/87) of the infants developed chronic HBV infection in spite of hepatitis B vaccination all
the children by acquiring HBV from their infected mothers as confirmed by twelve months of follow-up
This is a discussion of hepatitis B, hepatitis C and HIV in pregnancy, the optimal screening for these infections and the integration of management approach based on evidence. Lecture given during the 2018 PIDSOG post-graduate course "High-Yield OBGYN Infections 2.0: From Confusion to Clarity" at the Conrad Manila on November 12, 2018.
HIV positive mother and her bABY, RISK OF TRANSMISSION, ANTENATAL CARE, INTRA...LalrinchhaniSailo
Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%. As such, identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed and an offer of partner services.
In 2019, 85% of women and girls globally had access to antiretroviral therapy (ART) to prevent mother-to-child transmission (MTCT). However, high ART coverage levels do not reflect the continued transmission that occurs after women are initially counted as receiving treatment. Achieving retention in care and prevention of incident HIV infections in uninfected populations remain high priorities to reach global elimination targets. Since the global shift to, and accelerated rollout of, highly effective, simplified interventions based on lifelong ART for pregnant women living with HIV, virtual elimination of MTCT – also known as vertical transmission – has been shown to be feasible.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
hepatitis B.pdf
1. 4/16/2022
1
Hepatitis B in Pregnancy
Prof. Aboubakr elnashar
Benha university Hospital, Egypt
Aboubakr Elnashar
CONTENTS
1. EPIDEMIOLOGY& ETIOLOGY
2. DIAGNOSIS
1. Clinical
2. outcome
3. lab markers
3. TRANSMISSION
4. HEPATITIS & PREGNANCY
1. impact on pregnancy
2. impact of pregnancy
5. MANAGEMENT
1. Pre conceptional
2. Antenatal:
1. hbv-infected women who desire pregnancy
2. How to minimize the risk of transmission ?
3. Labour: mode of delivery
4. Postpartum:
1. breast feeding
2. Maternal follow up
3. Infant follow up
5. ALGORITHM
6. TAKE HOME MESSAGE Aboubakr Elnashar
1. EPIDEMIOLOGY & ETIOLOGY
Prevalence: 3.5% Africa: 6.1%
Of the 400 million individuals with chronic HBV worldwide:
50% acquired their infections perinatally.
90% of infected infants will become ch carriers
2nd carcinogens after tobacco (WHO)
In Egypt: The prevalence rate of HBV (1.3%-1.5%) has
declined after national infantile immunization.
Gish RG and AC Gadano. J Vir Hep. 2006.
Aboubakr Elnashar Aboubakr Elnashar
• ETIOLOGY
Family: Hepa DNA virus, whose DNA codes for four viral
products.
Nucleic ac structure: Circular double-stranded DNA with
single-stranded portions
Genome size: 3 - 4 Kb
Envelop: yes
Incubation period:
Long (up to 180 days).
Aboubakr Elnashar
2. DIAGNOSIS
CLINICAL PICTURE
Most infections during pregnancy: chronic, asymptomatic
Acute infection:±asymptomatic and anicteric.
50%: asymptomatic.
Physical Exam
Urticarial rash
Arthralgias and arthritis
Myalgias
Hepatomegaly and/or right upper quadrant tenderness
Jaundice is less common.
Aboubakr Elnashar
2. 4/16/2022
2
Outcome of acute HBV infection
Aboubakr Elnashar
HEPATITIS B LAB MARKERS
• Universal screening recommended: Maternal serologic testing
for HBsAg. If HbsAg positive, perform HBV DNA viral load
• HBsAg: Marker of current infection
HBeAg:
marker of active replication
at increased risk for transmitting HBV
HBV DNA: Viral load
Anti-HBs: resolved infection/immunity after immunization
Anti-Hbe: Identification of person with lower risk for
transmitting HBV
Aboubakr Elnashar
Aboubakr Elnashar Aboubakr Elnashar
3. TRANSMISSION
By any body fluid, but exposure to virus-laden serum is the most
efficient mode of transmission.
1. Maternal To Child Tansfer: Risk of vertical transmission: 30
% Related to maternal Viral Load
2. Sexual
3. Blood
Aboubakr Elnashar
1. MTCT
Aboubakr Elnashar
3. 4/16/2022
3
• In utero (<10%) (Gambarin-Gelwan Clinics Liv Disease 2007)
• Transplacental viral infection is uncommon {viral DNA is rarely found in
amnionic fluid or cord blood} (Towers et al, 2001).
• Associated with
• Acute HBV in 3rd trimester
• Maternal HBeAg and high HBV DNA
• History of threatened preterm labor
• HBV in the placenta
• At the time of delivery: Most neonatal infection is vertically transmitted by
peripartum exposure
• After birth
• Breastfeeding not associated with transmission 2
• ±related to scarification, other parenteral exposures
Aboubakr Elnashar
Mother-to-child transmission of virus in women with chronic viral hepatitis. Potential opportunities for
transmission of viral infection from mother to infant can occur in utero, or during the peripartum and postpartum
periods.Data on in- utero transmission of hepatitis viruses are limited and based on detection of viraemia in
newborns within days of birth. As prenatal invasive procedures can theoretically lead to transfer of infectious blood
or body secretions from the maternal to the fetal compartment, this risk needs to be considered when
contemplating their use. Mother- to- child transmission (MTCT) requires the mother to be viraemic. Thus, the risk
period in mothers experiencing acute hepatitis (from any of the hepatitis viruses) will be shorter than in mothers
with chronic hepatitis (hepatitis B virus (HBV), hepatitis C virus (HCV) or hepatitis D virus infection). In women
with chronic HBV or chronic HCV infection, the most common period of transmission is during the peripartum
Aboubakr Elnashar
Risk of Perinatal Hep B Transmission
Positive for HBsAg only: <10% of infants infected
Measurement of viral DNA has replaced eAg as the most
sensitive test of viral activity.
HBV DNA < 108 copies/mL= 0% transmission
HBV DNA > 108 copies/mL= 32% transmission
Without
immunoprophylaxis
HBIG and HBV vaccine
series
HBeAg positive 70-90% 5-10%
HBeAg negative 10-40% <5%
Aboubakr Elnashar
2. Sexual
Primary mode of transmission in US
by direct contact with
Blood, semen, vaginal fluids, saliva
It is STD: fortunately there HBV vaccine
Sex partners of HBsAg-positive persons (CDC, 2010)
counseled to use methods (e.g., condoms) to protect
themselves from sexual exposure to infectious body fluids,
unless they have been demonstrated to be
immune after vaccination (anti-HBs >10 mIU/mL) or
previously infected (anti-HBc positive).
Aboubakr Elnashar
4. HEPATITIS & PREGNANCY
IMPACT OF HBV ON PREGNANCY
Maternal risks
increased PTL, though studies are mixed.
Increased risk of gestational diabetes mellitus but no major
effect on other pregnancy outcomes.
Fetal risks: Related to PTL and gestational diabetes mellitus.
IMPACT OF PREGNANCY
Alanine aminotransferase (ALT) flares during pregnancy are
usually self- limiting, and reflect immunological and hormonal
changes.
Aboubakr Elnashar
Wedemeyer H, et al. Dtsch Med Wochenschr.2007;132:1775-1782.
EASL Clinical Practice Guidelines. J Hepatol.
Management
Liver disease
Treatment before and during pregnancy;
continue treatment after delivery
Advanced
Treatment before pregnancy; if response,
stop treatment before pregnancy
Moderate, no cirrhosis
Treatment in last trimester with “B”
category drug with post-partum
discontinuation
Mild, very high
viraemia
Pregnancy before treatment
Mild, low viraemia
5. MANAGEMENT
a. Periconceptional
Aboubakr Elnashar
4. 4/16/2022
4
b. Antenatal
Maternal prevention:
HBV vaccination recommended for pregnant women who are
HBsAg and at high risk of HBV acquisition
Serologic testing for immunity (HBsAb) prior to vaccination is
not required but may be cost effective.
• Maternal TT: Tenofovir Disoproxil Fumarate (TDF)
• recommended for pregnant women with elevated HBV viral
load
• starting at 28 w.
Aboubakr Elnashar
High-risk mothers who are seronegative CDC, 2010
Vaccine can be given during pregnancy.
Her husband infected with hepatitis B,
Household contacts of people infected with hepatitis B
Jobs that expose them to human blood or other body fluids
Travel to countries where hepatitis B is common
Ch liver or kidney disease,
kidney dialysis patients
Diabetes
HIV infection.
Aboubakr Elnashar
Aboubakr Elnashar
• Lamivudine
100 mg/day
From 28 t0 32 w
in patients with HBV DNA > 108 copies/m
Decreased transmission from 28.0% to 12.5%
No adverse events (van Zonneveld M, et al. J Viral Hepat.
2003;10:294-297).
Telbivudine (Tyzeka)
600mg/d
From 28-32 w
Aboubakr Elnashar
Results of giving antiviral therapy in 3rd T of pregnancy
Significant maternal HBV DNA reduction.
No significant changes in ALT, creatinine, or creatine kinase
No increased risk of maternal or f serious adverse events.
Infants have significantly less HBsAg, HBeAg, and HBV
DNA positivity compared with controls.
Rates of immune prophylaxis failure and MTCT are
significantly lower in infants
Aboubakr Elnashar
c. LABOUR
No role for caesarean delivery {No effect on HBV transmission}
Avoid amniocentesis
d. Postpartum
Breast feeding:
Provided the infant receives HBIG and HBV vaccination
Although virus is present in breast milk, the incidence of
transmission is not lowered by formula feeding
Maternal Follow-up:
ALT flares post-partum usually self-limiting; monitor for 3–6
months
Assess the need for antiviral treatment
Aboubakr Elnashar
5. 4/16/2022
5
Neonatal post-exposure prophylaxis
HBIG and HBV vaccine within 12 hs of birth for infants born
to women with HBSAg+ or unknown HBV status.
Universal HBV vaccination within 24 hs of birth for medically
stable infants >2kg born to women with HBSAg- status.
Birth dose vaccine is followed by completion of the 3-dose
infant vaccine series.
Infant Follow- up: Serology 3 months after completing
vaccination course, usually at age 9 months
Aboubakr Elnashar
MTCT prevention
1. Timely neonatal HBIG and vaccine birth dose (as
soon as possible within 24 hours of birth), followed
by a standard course of vaccine.
2. Maternal antiviral prophylaxis with tenofovir
disoproxil fumarate starting at 28–30 w
3. No role for caesarean delivery amniocentesis.
4. Postpartum maternal antiviral prophylaxis might be
considered in situations where infant HBIG not
available.
Aboubakr Elnashar
Aboubakr Elnashar
Algorithm for women positive for HBV.
a | A multifaceted approach is needed to identify and prevent mother- to- child
transmission of hepatitis B virus (HBV). All pregnant women need to be tested for HBV.
For mothers positive for the HBV surface antigen (HBsAg), a risk assessment for
mother- to- child transmission, maternal treatment if indicated and postnatal vaccination
of all newborn infants are the elements that need to be implemented. An assessment of
maternal HBV DNA level in the first or second trimester and determination of the need
for antiviral prophylaxis is key.
b | Caesarean section should be reserved for obstetric indications only. Timely
administration of neonatal hepatitis B immune globulin (HBIG) and vaccine is critical
and, in settings where HBIG is not available, extended duration of maternal antiviral
therapy to protect infants until they respond to vaccination is a consideration.
ALT, alanine aminotransferase; HBeAg, HBVe antigen; TDF, tenofovir disoproxil
fumarate.
Aboubakr Elnashar
Take Home Message
• Perinatal is the most common mode of transmission
• Best prevention for transmission is active/passive
immunization
• Perinatal transmission occurs despite appropriate infant
passive-active immunization
• Antepartum antiviral therapy can prevent MTCT
• Neonates that are correctly immunized can be breast-fed
Aboubakr Elnashar