Hepatitis with the future mother: how to recognize and cure. Can there be an erroneous analysis for hepatitis C during pregnancy if a hepatitis with

"It is precisely during pregnancy or its planning. This is due to screening among pregnant women to various infections, among which are hepatitis C, hepatitis B and HIV. According to statistics, in Russia, hepatitis markers are detected from each thirtieth pregnant woman. We will try to answer the main questions that arise from future mothers in this situation, selected, taking into account the activity of visitors to our site.

Does pregnancy affect the course of chronic hepatitis C (HGS)?

Pregnancy in patients with HSS does not adversely affect the course and forecast of the liver disease. The level of Alt is usually reduced or even comes to normal in the second and third trimesters of pregnancy. At the same time, the level of viremia is usually rising in the third trimester. Alt and viral load return to levels that occurred to pregnancy, on average 3-6 months after childbirth.

Is it possible to give birth with HCV? Does heneme with hepatitis C for pregnancy?

The studies carried out to date make it possible to assert that the HCV infection does not reduce the reproductive function and is not considered as a contraindication to conception and hacking pregnancy. HCV infection does not affect the state of the mother and the fetus.

Is hegered by hepatitis C from mother to the child?

Dozens of studies have been carried out on the risk assessment of the mother of the mother, according to the results of which the child's infection frequency ranges from 3% to 10%, is an average of 5%, and is regarded as low. The transfer of the virus from mother to a child can occur intranatally, that is, during childbirth, as well as in the prenatal and postnatal period (when care for a child, breastfeeding). The main value is infected during childbirth. In the prenatal and postnatal period, the frequency of infection of children from HCV mothers is extremely small. An important risk factor in the transfer of a virus from mother to the child is a viral load (the concentration of Hepatitis C RNA in serum). It is believed that the probability is greater if the mother's viral load is higher than 10 6 -10 7 copies / ml. Among all cases of infection, 95% fall on mothers with such values \u200b\u200bof viral load. Anti-HCV-positive and HCV RNA-negative (blood virus is not detected) mothers. The risk of child infection is absent.

Do you need to treat hepatitis with during pregnancy?

Given the features of the course of the CCS in pregnant women, as well as the adverse effects of interferon-α and ribavirin on the fruit, the PVT is not recommended during pregnancy. In some cases, drug treatment may be required (for example, the appointment of urthoxycholic acid drugs), aimed at reducing signs of cholestasis.

Do I need to make a caesarean section? Is it possible to give birth in the usual maternity hospital?

The results of research on the influence of the method of delivery (through the natural generic paths or cesarean section) to the frequency of infection of the child are dissected, but in most studies there are no significant differences in the frequency of infection of the child, depending on the method of delivery. Caesarean section sometimes recommended women with high viremia (over 10 6 copies / ml). It has been established that mothers with a combined HCV-HIV infection, a planned caesarean section reduces the risk of HCV infection (as well as HIV), and therefore such pregnant women choose a way of delivery (only planned caesarean section) is based solely on HIV status. All women x HCV infection give birth in ordinary maternity hospitals on general grounds.

Is it possible to breastfeed when hepatitis C?

With breastfeeding, the risk of hepatitis transmission is extremely low, so it is not recommended to abandon breastfeeding. However, when feeding, you need to pay attention to the state of the nipples. Microtraums of the nipples of the mother and contact of the child with its blood increase the risk of infection, especially in cases where the mother has a high viral load. In this case, it is necessary to temporarily stop breastfeeding. In women with a combined HCV-HIV infection, breastfeeding feeding, the frequency of infection of the HCV of newborns is significantly higher than with artificial feeding. Such women apply recommendations developed for HIV-infected people prohibiting breastfeeding newborns.

The child found antibodies to the virus. He is sick? When and what are the tests need to do?

All newborns from HCV-infected HCV mothers in serum are detected by maternal anti-HCV penetrating over the placenta. Maternal antibodies disappear during the first year of life, although in rare cases they can be detected up to 1.5 years. The diagnosis of HCV infection in newborns can be based on the detection of HCV RNA (the first study is carried out in the period from 3- to 6 per month), but it must be necessarily confirmed by the re-detection of HCV RNA (due to the possibility of the transient nature of Viremia), and Also identifying Anti-HCV aged 18 months.

In a child of HBHs. What is the disease forecast? Does vaccination from other hepatitis need?

It is believed that in the intracatal and perinatal period of children, hepatitis C flows softly and does not lead to the development of cirrhosis and hepatocellular carcinoma (ICC). However, the child should take place annually to monitor the course of the disease. Due to the fact that superinfection of hepatitis A viruses or in may worsen the forecast of HCV infections, vaccination against hepatitis A and B should be carried out in HCV-infected children.

Hepatitis B and Pregnancy

Is it possible to vaccinate from hepatitis in during pregnancy, breastfeeding?
The effect of HBSAG antigens on the development of the fetus at the moment is not fully studied, therefore, during pregnancy, hepatitis vaccination is needed only at a high risk of infection. Random introduction of the vaccine is not an indication for the interruption of pregnancy. No negative effects during vaccination during the lactation period were not detected, so breastfeeding is not a contraindication to the introduction of the vaccine.

General recommendations for pregnant women infected with HCV and their children:

It is advisable to study the HCV-Viremia level in the third trimester of pregnancy in all pregnant women having anti-HCV in serum;
- It is recommended to avoid amniocentesis, the imposition of electrodes on the skin of the fetus, the use of obstetric forceps, as well as a long anhydrous generation period, especially in women with a high level of viremia;
- there is no reason for the recommendation of the planned cesarean section in order to reduce the risk of child infection;
- It is not recommended to prohibit breastfeeding of a newborn;
- All children who are diagnosed with perinatal HCV infection are subject to observation, including children with non-permanent viremia.
For women with HCV-HIV coinfection, apply recommendations developed for HIV-infected:
- Mandatory planned caesarean section and prohibition of breastfeeding.

Chronic hepatitis C and pregnancy

Only so you can appreciate the state of the health of the future mother and baby, to correlate the results with the expected risks. How to be if - like a thunder among a clear sky, is hepatitis C?

The dilemma on pregnancy is also facing women who are known about infections, but they are planning the birth of a kid. Hepatitis C and Pregnancy - Is it possible in principle?

The reasons

The hepatitis C (HCV) virus contains in the RNA genome or ribonucleic acid and refers to the family of flaviviruses. It has six different genotypes, which are due to permutations in a nucleotide chain.

The disease occurs everywhere on the globe; The risk of infection does not depend on age, gender and racial affiliation.

There are several paths of hepatitis from:

Parenteral. This path implies a virus in the blood. The most common reasons are the use of injecting drugs, invasive medical and non-medical manipulations associated with impaired skin integrity and mucous membranes (endoscopic studies, tattoos, manicure), hemotransphus (blood transfusion), hemodialysis.
Sexual. The pathogen penetrates the body from an infected partner with unprotected sexual intercourse. It is noteworthy that the frequency of infection during monogamous relations is lower than with frequent sexual contacts with different people. Hepatitis with her husband requires special caution, pregnancy and childbirth need to be planned in advance with the implementation of all the instructions of the doctor.
Vertical. Pregnancy in hepatitis C in a woman is the cause of a possible transmission of the virus to the fetus transplascentary (through the vessels of the systemic-placental blood flow system) and during the generic process.

Conducted clinical studies have proven that HCV infection does not affect the frequency of stillbirth, spontaneous abortion, anomalies development and reproductive function as a whole. However, hepatitis C in pregnant women depending on the degree of liver damage is of great importance for the risk of premature birth and the birth of a child with a low mass body.

Symptoms

The incubation period is from two weeks to six months, and the sharp form does not often manifest itself, remaining unrecognized. In most cases, it turns out that he found hepatitis with accidentally in chronic form.

During pregnancy, immunity is suppressed to preserve the baby, which the immune system perceives as an alien protein, because the chronization of infection is a spread phenomenon.

There is a latent - asymptomatic period between the acute and chronic phase, when there is no reason for complaints of health.

It can last for years, but sharply shrinks if a woman is given chronic pathology of the liver or any other organism systems, especially when the autoimmune process (aggression of immunity against its own cells and tissues).

The symptoms of the acute phase are very similar to the exacerbation of chronic. They include:

weakness, fatigue, reduced tolerance to physical exertion;
nausea, vomiting, lack of appetite;
increasing body temperature;
severity and pain in the right hypochondrium;
reducing body weight;
the jaggility of the skin, mucous membranes and scool eyes;
increase in liver (hepatomegaly), spleen (splenomegaly);
damage urine, gray color masses.

The danger of the chronic form of hepatitis C is the formation of the liver cirrhosis.Pregnancy can intensify its current, revealing bright clinical symptoms due to increased liver load. This is especially important with the already developed portal hypertension and liver cellular failure.

Risk of infection of the child

The frequency of transmission of the pathogen vertically is about 10%. Infection of the child is possible at:

women's blood mixing with the blood of the fetus when breaking small placental vessels;
contact with the blood of the mother in the presence of damage to the skin and mucous child during the delivery process.

Pregnancy and childbirth in hepatitis with put a woman before the question of breastfeeding. The concentration of virus in milk is insignificant, so the lactation path of infection is considered unlikely.

The exceptions are bleeding abrasions and other damage to the nipples, the co-infection of HIV, hepatitis V. The frequency of infection is higher when the obstetric nippers are imposed, as well as other manipulations that are potentially able to disrupt the integrity of the skin and mucous membranes.

The patient should be informed about the intended risks associated with the passage of the child through natural generics and breastfeeding.

According to research, the planned caesarean section reduces the risk of fetal infection with a large virus load in a woman, therefore it is recommended as a preventive measure. The consequences for the child during pregnancy flowing against the background of hepatitis C, it is impossible to accurately predict.

The screening program (targeted detection) of hepatitis C during pregnancy is not yet implemented for widespread use. This is explained by the high cost of research.

The allocation of women with risk factors (injecting drug addiction, hemodialysis, or hemotransfuses, infected by sexual partner), is recommended testing for virus detection.

Hepatitis C pregnant women are diagnosed with such methods as:

The newborn has parent HCV antibodies in the blood for 12-18 months, so it is impossible to establish an accurate diagnosis of hepatitis C in the first one and a half years of life.

Treatment

Standard therapy with interferon - Ribavirin and Viferon preparations - pregnant women are not carried out in connection with the estimated teratogenic (congenital deformities) with the impact on the fetus and not enough influence on the remaining aspects of the transaction of the gestation period.

If hepatitis C during pregnancy proceeds without complications, a woman is appointed with a diet with the exception of alcohol, strong tea and coffee, fatty, fried, sharp types of food, as well as hepatoprotective therapy with vitamins of the group B, Essential, Silimarin.

Prevention

Since hepatitis C is transmitted through blood, it is necessary to level the risk, if possible, avoiding contact with it. While working with biological fluids, you need to wear gloves, mask and glasses, use disinfectant solutions.

During invasive procedures, only disposable or thoroughly sterilized tools are needed. Blood transfusion must be carried out from proven donors.

In order to avoid infection, the child can recommend the planned operation of the cesarean section, rejection of breastfeeding and the transition to artificial mixtures. The systematic observation of the health of the baby and the conduct of laboratory studies is established to diagnose the possible infection.

Forecast

Pregnancy, especially multiple or accompanied by the concomitant pathology of the liver or other organs and systems, is the risk itself, and the presence of an active viral process aggravates the current. Successful delivery is possible at low viral load at the compensation stage, when the liver functions are not critical.

It is not guaranteed to prevent the virus transfer to the child even when using cesarean sections with subsequent artificial feeding. Pregnancy after the treatment of hepatitis C has the likelihood of the development of pathology, so a woman should pass a comprehensive diagnosis before conception.

It is necessary to remember the cessation of drugs due to their teratogenicity, which is possible only when maintaining restoration liver reserves.

The infection of the population with hepatitis C (HCV) allocated in 1989, high all over the world, and currently there is a further increase in morbidity. Hepatitis C is characterized by a tendency to develop a chronic process, limited clinical symptoms and a poor reaction to antiviral therapy. Most cases of hepatocellular carcinoma are connected with this virus. In this article we will look at pregnancy against the background of hepatitis S.

Bearer hepatitis C during pregnancy

The causative agent of hepatitis C during pregnancy is a RNA-containing virus. A feature of it is the existence of a larger number of different genotypes and subtypes (about 30), differing from each other with different sequences of nucleotides. In Russia, the most common subtypes 1b, 3a, 1a, 2a are the most common. It is subtype 1B that correlates with the maximum frequency of the development of hepatocellular carcinoma, and the subtype is most often revealed from drug addicts.

Hepatitis with when tooling the child is capable of persistence. The most popular explanation of this is today the phenomenon of "immunological traps", while the virus undergoes changes in the genome. During the baby tooling, a quick restructuring prevents the immune system to affect it with neutralizing antibodies. There is an assumption that such changes may be provoked by the impact of the immune system of the host. In addition, as well as for other RNA-containing viruses, errors in replication are characteristic of hepatitis, which causes a large amount of mutations in the synthesis of surface proteins of subsidiaries.

In Europe, the frequency of hepatitis C carriers is 0.4-2.6 per 1000 people. Sources are patients with chronic and sharp forms of hepatitis C, as well as latent carriers of infection.

Transfer paths - parenteral and vertical from pregnant to the fruit. In connection with the mandatory screening for hepatitis blood donors and the disinfection of all drugs, the transfusion path of infection today is practically not found, but still possible due to the long incubation period of infection, during which anti-HCV in the blood is not detected, and blood is possible infected donor. This period ("window") is on average 12 weeks, but can last up to 27 weeks. At this time, it is possible to confirm the presence of an infection by detecting the antigen by the PCR method.
Continated and domestic and sexual path of infecting is rare. Separate partners of HCV-infected people are rarely infected even with long-term contact.
The risk of infection with hepatitis C with injected needles is not more than 3-10%. Therefore, the main way to infect children with hepatitis remains a vertical path - from a pregnant woman to the fetus.

Hepatitis infection risk factors:

the use of intravenous drugs and drugs in history;
blood transfusion in history;
availability of sexual partner who used drugs;
STIs in history;
tattoos and piercing;
dialysis;
antibodies to hepatitis B or HIV;
the presence of several sexual partners;
identification of hepatitis in mothers of pregnant women.

Symptoms

In most cases, the sharp phase of hepatitis C during pregnancy remains unrecognized. Jaundice develops in 20% of pregnant women. Other symptoms are weakly pronounced and characteristic of all viral hepatitis. After 1 week, after infection, it is possible to identify it with PCR. Antibodies appear in a few weeks after infection. In 10-20% of cases, the development of a transient infection with the elimination of the virus is possible, in which the patient does not acquire immunity and remains susceptible to reinfection with the same or other strain. Acute hepatitis with both latent and clinically manifesticity in 30- 50% of cases may result in recovery with full HCV elimination. However, in most cases, it is replaced by a latent phase with a long-term persistence of the virus. The latent phase is reduced in the presence of a background disease of the liver and other intercurrent diseases. During the latent phase, infected persons consider themselves healthy and no complaints are presented.

The incubation period of hepatitis C lasts from 2 to 27 weeks, constituting an average of 7-8 weeks. During pregnancy, the disease is divided into three phases - sharp, latent and reactivation phase. Acute infection due to hepatitis C, in 80% of cases proceeding without clinical manifestations and approximately 60-85% of cases goes into the chronic form of hepatitis with the risk of development of the liver cirrhosis and hepatocellular carcinoma.

The consequences of hepatitis C during pregnancy

In Russia, screensing to hepatitis C, in many countries such studies are considered inappropriate due to the lack of measures of maintenance and prevention in pregnant women. In the presence of hepatitis markers with pregnant women should be observed at the hepatologist. After an additional examination, the hepatologist makes it conclusion about the possibility of a delivery in a conventional maternity hospital in the absence of signs of activation of infection.

There is no consensus on the optimal way to root the pregnant women with hepatitis. Some experts believe that Cesarean section reduces the risk of fetal infection, while others deny it. Premature rupture of the fruit bubble and a long anhydrous gap increase the risk of transmission of infection. If hepatitis C is detected during pregnancy, it is possible to explore the umbilical blood for the presence of hepatitis C markers, although even with a diagnosis, the child's age before 2 years is contraindicated for the existing antiviral therapy. Hepatitis C is found in breast milk, and therefore the discussion about the safety of breastfeeding is still being carried out. The concentration in milk depends on the level of virus replication in the blood, so breastfeeding can be saved in cases with the absence of virus.

Neonatal HCV infection

All children born from anti-HCV-positive pregnant women will also be anti-HCV-positive on average during the first 12 months of life due to transplascent transfer of maternal IGG. If antibodies are preserved more than 18 months after birth, it is a confirmation of the child's infection with hepatitis C. About 90% of vertically infected children are HCV-PHK-positive to 3 months of life, the remaining 10% become positive by 12 months.

The reactivation phase corresponds to the beginning of the clinically manifest stage of hepatitis C, followed by the development of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. In this period, Virushemia with high blood HCV-PHK and anti-HCV is clearly expressed. Cirrhosis develops in 20-30% of chronic carriers for 10-20 years. Hepatocellular carcinoma occurs in 0.4-2.5% of patients with chronic form, especially in patients with cirrhosis. Extractive manifestations of hepatitis C include arthralgia, Reino disease and thrombocytopenic purpura.

In pregnant women with chronic hepatitis with anti-HCV are found in the blood not only in free form, but also in the composition of circulating immune complexes. Anti-HCV-IgG is determined when screening research, to confirm seroconversion and monitoring in the treatment of interferons. Only 60-70% of anti-HCV-positive patients are HCV-RNA positive. The discovery of hepatitis C in the blood confirms the virushemia, indicating the ongoing active replication.

When confirming replicative activity, treatment outside pregnancy is carried out by alpha interferon, inhibiting the introduction of the virus into hepatocytes, its "undressing" and the synthesis of mRNA and proteins. Vaccines from hepatitis from today does not exist due to the rapid mutagenity of the virus and insufficient knowledge of its interaction and the immune system. Features of pregnant women with hepatitis C. The frequency of detection of HCV-PHK in pregnant women is 1.2-4.5%. There is no negative impact on the course of hepatitis with pregnancy. All women are conducted screening examination for hepatitis from three times for pregnancy. Very little know about the influence of infection on pregnancy. In most women, hepatitis C during pregnancy flows asymptomatic and approximately 10% there is an increase in the level of aminotransferase. According to some data, the infection does not correlate with the increased frequency of adverse complications and outcomes of pregnancy and childbirth.

Consequences for fruit

Although it is possible to vertical transmission of the fetus virus, hepatitis C and pregnancy are not contraindicated. The risk of intrauterine infection with hepatitis C does not depend on the time of infection of the mother and is approximately 6%. But decisive is that the vertical transmission of infection in a newborn is observed with a high degree of virus replication in the mother's body. Antenatal and intranatal transmission is possible. Recent studies have shown that only those fruits are subject to intrauterine infection, the mothers of which are observed by HCV-infected with lymphocytes. The combination of hepatitis C with HIV infection enhances the risk of vertical transmission of the virus, since on the background of immunosuppression there is a large activation of the virus (the risk is 10-20%). The smallest risk of intrauterine infection takes place at HCV seroconversion during pregnancy.

To date, many women are a carrier of viral hepatitis C, but I do not know from that. Often they learn about their diagnosis, being pregnant. In most cases, this information is shocking and frightening for a pregnant woman. There is a question about the possibility of tooling and the birth of a healthy child.

What is hepatitis

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

Hepatitis C refers to a viral group of diseases. Promotes development and malignant neoplasms.

To date, this species is the most dangerous. A characteristic hidden form of illness often leads to serious complications. Are the cause of disabilities or death.

How pregnant can get hepatitis with

Viral hepatitis with widespread worldwide. He is considered to be a disease of young. Most often, it is diagnosed in people under the age of 30.

Main paths of infection:

Tattoo applying.
Piercing piercing.
Introduction of the injection with a common needle (including drug addiction).
Sharing personal hygiene (toothbrushes, razors, manicure tools).
During operations.
In the treatment of teeth.
Unprotected sexual contact with infected person.

Thus, the main way of infection with hepatitis C is blood and sex liquids.

The disease is not transferred by air-droplet, through hugs and handshakes, when using a common kitchenware.

Perhaps joint accommodation with a sick person, subject to all precautionary measures.

Pregnancy can provoke the development of hepatitis C if women before it was his carrier. This is due to the decrease in the efficiency of the immune system.

Is the fetus transmitted

Each woman who was diagnosed with hepatitis C during pregnancy is experiencing about the possibility of infection and consequences for the child.

The probability of infection exists, but it is quite small.

Doctors argue that the likelihood of a child's intrauterine infection does not exceed 5%.

Also, it is believed that the possibility of infection is precisely in the process of birth higher than during the period of to wear. Since the risk of mother's blood getting into the child's body increases.

Methods for transferring a virus from mother to a child:

in the period of childbirth - when maternal blood in the child's body gets;
the newborn child can get a virus from the mother at the time of care for it - the treatment of umbilical cord. However, if observing precautions, the probability of such infection is small;
during breastfeeding period - if traumatization of nipples (cracks or ulcers) occurs.

After the birth of a child, they put control and regularly check its blood for the presence of antibodies. Analyzes take aged 1, 3 and 6 months.

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

If the results of the analysis are positive, the child will prescribe the appropriate treatment.

Types of disease and their influence on pregnancy

2 forms of the flow of viral hepatitis C are isolated:

Acute;
Chronic.

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

Often, pregnant women show this kind of hepatitis.

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

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

Along with this, this form is often the cause of premature genera and lagging behind the child in growth. This is due to the presence of a liver cirrhosis in the mother.

In the case of a positive result, it will be carried out by the necessary consultation and the tactics of behavior in the current situation is explained.

If the result of the analysis is dubious, that is, the opportunity to further conduct a study called. It will accurately determine the presence of a disease in a woman.

Treatment of hepatitis C in pregnant women

Medical drugs that are used to treat hepatitis with contraindicated during pregnancy. This is due to the fact that they provoke the development of intrauterine pathologies for the development of the fetus.

In most cases, all treatment at the time of pregnancy stops or does not even begin.

In some cases, it is necessary to conduct medicinal therapy.

Typically, drugs are prescribed in cases of gall stagnation or if stones were detected.

It is necessary to understand that even if it was necessary to appoint medicines, they will be selected in such a way as to inflict the least harm to the future child.

If a pregnant woman has an acute form of hepatitis C, then all treatment will be aimed at preserving pregnancy. In this case, the threat of miscarriage is significantly increased.

How to give birth to hepatitis with

To date, there is no single medical opinion on the issue of the method of pregnant women, which is infected with viral hepatitis S.

It is believed that the risk of child infection in childbirth is significantly reduced if they carry out the operation.

In Russia, hepatitis infected with women have the right to choose a way of delivery. Doctors are obliged to inform the hospital about possible risks and complications.

Also, the guideline for choosing a kind of childbirth is the level of virus load of a woman.

If it is high enough, then preference should be given to Cesarean cross section.

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

The question "Is it possible to give birth to hepatitis C?" It has a unambiguous answer "yes." Even in the presence of a disease in the mother, the chance to give birth to a healthy child is quite large.

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