Viral hepatitis C and pregnancy. The risk group for infection with hepatitis C includes. Types of disease and their impact on the course of pregnancy

Many women learn about hepatitis during pregnancy at later dates. This is due to the fact that such studies for the presence of markers of an infectious nature are provided for by the medical records of a pregnant woman. The statistics of hepatitis in pregnant women are disappointing. Medicine fixes such a disease in every thirtieth pregnant woman. And this fact raises many questions. Will the disease harm the health of the child? Is it possible to treat the disease during pregnancy?

What is hepatitis, symptoms

The etiology of hepatitis is viral. The causative agents of the disease can be viruses A, B, C, D, E. Some forms of the disease (hepatitis A and B) were studied quite recently, in the 70s of the last century. Since that time, screening for the presence of a certain form of hepatitis has been carried out. Later, by examining donated blood, a new strain of viral hepatitis, form C, was identified. The danger of this type is that it can be transmitted with blood. And this is a direct way of infection of the child during pregnancy.

The prevalence of hepatitis C virus in different countries different. For example, in the United States, a critical level of C virus antibodies is found in 1-3% of pregnant women, and in Egypt this number reaches 14%. Prior to the isolation of C virus antibodies, the disease was transmitted through donated blood. But with the introduction of blood control, the amount of the virus decreased. Also, a person can become infected through sexual contact and when using non-sterile medical instruments.

Hepatitis C disease is widespread among drug addicts due to the reusable use of syringes. The acute form of hepatitis tends to become chronic. In this case, the patient may not even feel any somatic changes.

In the majority of patients during long period time the symptoms do not appear at all. But irreversible processes take place in the body. For such insidiousness, hepatitis C is also called the “gentle killer”.

20% of patients still notice a deterioration in well-being. There is weakness, decreased efficiency, drowsiness, nausea, loss of appetite. Some even lose weight. There may be discomfort in right hypochondrium. Sometimes the disease manifests itself only with joint pains or various skin manifestations.

The analysis for hepatitis C blood delivers no difficulties.

And there is no need to delay treatment. Otherwise, 6-8 years after infection, hepatitis can lead to cirrhosis of the liver. Hepatitis is difficult for children and the elderly.

hepatitis during pregnancy

An analysis for hepatitis in pregnant women with chronic hepatitis shows a positive trend towards a decrease in antibodies in the second and third trimesters of pregnancy. The number of viruses increases after childbirth.

Despite the fact that during pregnancy and labor activity hepatitis does not affect, the risk of transmission of viral hepatitis from mother to child during pregnancy still exists. The results of a study of infected pregnant women showed that at birth, from 2% to 9% of newborns were identified with a form of hepatitis. Compared to other hereditary diseases, this is a fairly low threshold.

Studies show that the most favorable moment for infection of a child is considered to be labor activity and postpartum care for the child. Most cases of hepatitis infection occur during childbirth. Therefore, the use of drugs by a pregnant woman and features medical support during childbirth - these are the main points that you should pay attention to.

Pregnancy history criteria

The study of the anamnesis of a pregnant woman is associated with the presence of certain factors that, taken together, are favorable for hepatitis infection in a pregnant woman or a woman planning a pregnancy. In medical practice, such a “risk group” includes the following categories:

women with an HIV-positive factor;
women who have used injecting drugs in the past;
in cases where the sexual partner used drugs;
when transfusing blood or substitutes;
with hemodialysis;
with a tattoo or piercing.

These criteria indicate that when taking a history of a pregnant woman, doctors include such a woman in the “risk group” and conduct a more thorough examination.

Treatment of pregnant women with hepatitis

First of all, the use of therapeutic agents during pregnancy will require an assessment of the condition of all physiological systems women. For this, screening for the presence of other chronic diseases is carried out. A pregnant woman should be informed about the level of infection and the possibility of transmission of the virus to the child.

The use of antiviral drugs during pregnancy has not been sufficiently studied to date. Typically, therapy to reduce the viral load on the liver uses interferon and ribavirin. But during pregnancy, ribavirin significantly affects the development of the fetus. As for another drug, interferon, it is quite easily tolerated by women during pregnancy and does not contribute to the development of fetal pathology.

IN complex therapy use drugs containing ursodeoxycholic acid. This reduces cholestasis of the liver. Many causes the use of vaccination during pregnancy. It is used on rare occasions high level infections. But the effect on the child is not fully understood. If the vaccine was administered by accident, then there is no need to terminate the pregnancy. Practice shows that the accidental use of vaccination does not affect the development of the fetus. Such contraindications have not been identified during breastfeeding.

Generic activity in hepatitis

In medicine, there is not enough information about whether the risk of infection of the child during caesarean section will decrease. Only correct solution- This medical indications to carry out such an operation during labor.

Research on this issue in various medical scientific centers quite contradictory. For example, Italian doctors claim that caesarean section reduces the risk of transmission of the hepatitis virus from mother to child by a ratio of 6% to 32% in relation to natural childbirth. A american doctors, on the other hand, point to increased risk transmission of the virus in surgical intervention in the ratio of 13% to 5%. The pregnant woman should be informed about these data.

In cases of voluntary choice of labor, a pregnant woman must take into account all the risks of transmitting infectious hepatitis. In this case, a woman should know her level of viral intoxication. If the viral load is in the range of 100-107 copies per ml, then this amount increases the risk of infection during caesarean section.

The question of the possibility of breastfeeding with hepatitis is discussed by the attending physician and the mother. Studies by German scientists have shown that the presence of hepatitis RNA in breast milk was not detected. In similar studies by Japanese scientists (30 nursing mothers), these figures were confirmed.

In only three cases, hepatitis substances were detected in small quantities. This is quite understandable. After all, the level of hepatitis RNA in the blood serum significantly exceeds the presence of such substances in breast milk. At the same time, there is no evidence of infection of the child during breastfeeding. Exceptions are HIV viruses and lymphocytic leukemia-lymphoma-1 (HTLV-1), which can be passed through breast milk.

The only caveat in breastfeeding is to the mother. The fact is that during feeding, trauma to the nipples is possible, and such contact can provoke an exacerbation of hepatitis in the mother.

In general, hepatitis C in pregnant women does not affect the pathology of the fetus.

Compliance with the prescriptions of doctors and constant medical supervision will reduce the risk of infection of the child to a minimum.

Viral hepatitis C (HCV) is one of the most urgent and unresolved problems, which is determined by the severity of the course and the prevalence of the disease. The urgency of the problem becomes even more significant in obstetrics and pediatrics due to the steady increase specific gravity diseases, a high risk of intrauterine infection and the possibility of infection of the newborn during childbirth and the postpartum period.

The causative agent of hepatitis C is a single-stranded RNA virus that belongs to a separate genus of the flavivirus family. The different nucleotide sequence forms at least six genotypes. Although the hepatitis C virus occurs in all countries of the world, its prevalence, as well as the structure of genotypes, varies. For example, in Europe and the USA, the presence of antibodies to the hepatitis C virus is found in 1-2% of the population, while in Egypt approximately 15% have a positive reaction to these antibodies. In addition to sexual contact and vertical transmission (from an infected mother to her child), hepatitis C is also transmitted through blood. Donated blood and blood products used to be its main source, but it has now been virtually eliminated thanks to the introduction of blood testing. Most of the new infections occur in drug addicts using non-sterile syringes. At sexual contacts the possible transmission of the virus varies, for example, in individuals maintaining stable monogamous relationship with an infected partner, the risk of infection is less than in persons with multiple sexual partners. A Spanish study found that unprotected extramarital sex is a risk factor for hepatitis C antibody testing. It is believed that the risk of acquiring hepatitis C infection increases with the number of sexual partners. The manifestations of acute infectious hepatitis C are not clinically pronounced, and only a small number of patients develop jaundice. However, the infection becomes chronic in about 85% of cases, and then almost all patients develop histological signs of chronic hepatitis. In addition, approximately 20% of patients develop cirrhosis of the liver 10-20 years after the initial infection. The complications of this disease also include malignant hepatoma and extrahepatic symptoms.

Because virus replication is slow in tissue culture and antigen detection systems are not available, clinical diagnosis is limited to either detection of hepatitis C serology (antibodies to hepatitis C virus (anti-HCV)) or detection of the viral genome (HCV RNA). The first generation of serological samples were tested for antibodies using non-structural protein C100. Although these tests were not sufficiently sensitive and specific, they significantly reduced the prevalence of post-transfusion non-A and non-B hepatitis during the screening of donated blood. Inclusion in second and subsequent generations of assays various kinds antigens (structural and non-structural) improved their sensitivity and specificity. Despite this, false positives remain a significant problem, especially in populations at low risk of infection, such as blood donors. The specificity of the serological reactivity of an enzyme-linked immunosorbent assay (more precisely, an enzyme-labeled immunosorbent assay) is usually confirmed by additional tests, such as recombinant immunoblot studies. Anti-HCV detection is used to diagnose infection in patients with chronic hepatitis, liver cirrhosis, malignant hepatoma, as well as to check donated blood and organs. However, antibody development sufficient to detect them sometimes occurs several months after an acute hepatitis C infection, so one of the shortcomings of current serological assays is their inability to detect acute hepatitis C infection of this type.

Acute hepatitis C is diagnosed by identifying the viral genome using polymerase chain reaction. Hepatitis C virus RNA can be detected in the patient's serum prior to seroconversion. Since hepatitis C is caused by an RNA virus, the viral genome must be transcribed into DNA (reverse transcription polymerization reaction) until it replicates by single or double polymerization chain reaction. More recently, assays have been developed to determine the number of viral genomes. The calculus of viral genomes has importance to monitor the response to antiviral therapy and assess the infectivity of the individual. The latter is directly related to the transmission of hepatitis C virus from mother to child.

Screening for hepatitis C antibodies during pregnancy. Currently, antenatal screening programs for hepatitis B and HIV infection are widely used. The introduction of a similar program for hepatitis C deserves further discussion. Here it is necessary to take into account the prevalence of this infection and preventive measures aimed at protecting the health of newborns. In the United States and Europe, the prevalence of antibodies to the hepatitis C virus in the blood serum is 1%. If the rate of vertical transmission is approximately 5% (although it varies depending on the clinical setting), then 2000 pregnant women would need to be screened to detect one case of vertical transmission of the virus. The cost of hepatitis C testing also means that the introduction of universal screening programs for pregnant women will place a significant financial burden on clinics. An alternative strategy might be to screen women at high risk of contracting the virus (e.g., injection drug users, those infected with the human immunodeficiency virus (HIV) or hepatitis B virus, and those who received blood transfusions prior to the introduction of blood donation tests) and their testing for antibodies to the hepatitis C virus during pregnancy. It is not necessary to make a clinical history of attacks of acute hepatitis in this case, since most infected people will not have any symptoms. Supporting such targeted screening programs is the fact that syringe users now account for the majority of new infections in the United States. However, this approach is criticized from the point of view that 50% of patients in the region will not be detected, since approximately half of all infected people are in the group exposed to risk factors for infection. Despite this, from our point of view, screening programs should be carried out at least among pregnant women, assuming their expansion in the future to a wider population.

Principles of treatment. WITH various results for the treatment of hepatitis C, alpha- and less often beta-interferon are used. In general, 15-20% of patients treated with alpha interferon for 6 months develop a long-term reaction (in the form of normalized serum aminotransferase and the absence of hepatitis C virus RNA in serum at the end and within 6 months after therapy). Treatment is usually given to patients with persistently elevated aminotransferase levels and histological evidence of chronic hepatitis. Weak response to therapy is associated with cirrhosis of the liver, high levels of hepatitis C virus RNA in the blood serum before treatment, and hepatitis C virus genotype 1. Other drugs have been used as additional therapeutic measures - currently ribavirin, a nucleoside analogue, is especially widely used. It is believed that the combination of drugs can significantly improve the rate of recovery, as evidenced by the results of one study, where the use of one interferon was compared with a combination of interferon and ribavirin and, as a result, the results improved from 18% to 36%.

Treatment of women during pregnancy

For the treatment of pregnant women infected with the hepatitis C virus, a general assessment of the health of the mother should be carried out. First of all, it is necessary to examine the woman for the presence characteristic features chronic liver diseases. In the absence of liver failure, a more detailed hepatological examination is performed after the birth of the child. General recommendations during pregnancy include information about the low risk of sexual transmission and practical advice about how to avoid household transmission of the virus through the blood (for example, use only your own toothbrushes and razors, carefully bandage wounds, etc.). With regard to the possibility of sexual transmission, if there is an infected patient in the family, it is recommended to test relatives at least once for anti-HCV. Although the decision to use a condom is entirely up to the couple, it must be emphasized that transmission of the hepatitis C virus through sexual contact in stable couples is unlikely and occurs quite rarely.

An infected pregnant woman should know how the presence of the disease will affect pregnancy and childbirth, as well as the possibility of infection. Studies have reported mother-to-child transmission of hepatitis C virus with varying rates of transmission (0% to 41%). In general, it is believed that 5% of infected mothers who are not infected with HIV transmit the infection to their newborns. Maternal viral load is an important risk factor for vertical transmission: it is known to be more likely if the concentration of hepatitis C virus RNA in the mother's blood serum is more than 106-107 copies/ml. Comparison of the degree of transmission of the virus according to the materials of various clinics showed that only 2 out of 30 women who transmitted the infection to a child had a viral load of less than 106 copies / ml. If a patient is co-infected with HIV, this increases the likelihood of transmission of hepatitis C virus (from 3.7% among patients with hepatitis C to 15.5% among women infected in addition to the human immunodeficiency virus), possibly due to an increased level of RNA hepatitis C virus in the mother. Therefore, maternal viral load should be measured during pregnancy, presumably in the first and third trimesters. This would allow a more accurate assessment of the risk of possible transmission of the infection to the newborn. Where possible, prenatal diagnostic techniques should not be used because of the potential for intrauterine transmission. Their conduct must be fully justified, and the woman should be informed accordingly. However, there is no evidence that during pregnancy, acute or chronic hepatitis C infection increases the risk of obstetric complications, including abortion, stillbirth, premature birth or birth defects. A documented case report of acute hepatitis C in the second trimester of pregnancy reported no mother-to-child transmission. The role of antiviral therapy during pregnancy requires further study. In theory, reducing hepatitis C viral load should reduce the risk of vertical transmission. However, interferon and ribavirin have not been used to treat pregnant women, although interferon alpha has been used to treat chronic myelogenous leukemia in pregnant women. Such patients with hematological malignancies tolerate alpha-interferon well, and children are born normal. There is a possibility that pregnant women infected with high-titer hepatitis C virus will be treated in the future.

Management of childbirth in women with viral hepatitis C

The best way to give birth infected women not definitively determined. According to Italian scientists, the degree of transmission of infection is less during childbirth with the help of caesarean section compared to vaginal delivery (6% versus 32%). In another study, 5.6% of babies born after a caesarean section were also infected with hepatitis C, compared with 13.9% of those born vaginally. This information should be provided to pregnant women infected with hepatitis C, and whether or not she chooses a caesarean section, it is important that this be done on a voluntary basis. This would help optimize the process of preventing transmission to the child. When making a decision, it is important to know the mother's hepatitis C viral load. For women with a viral load greater than 106-107 copies/ml, a caesarean section is recommended as the optimal delivery method. If a woman decides to give birth through the birth canal, it is necessary that the possibility of infection of the child be minimized.

Lactation

This issue should be discussed in detail with the infected mother. According to studies by Japanese and German scientists, hepatitis C virus RNA was not found in breast milk. In another work, it was studied breast milk 34 infected women and the result was similar. However, according to other sources, hepatitis C virus RNA has been found in breast milk. The possible transmission of hepatitis C virus through breast milk is not supported by the results of studies, and in addition, the concentration of hepatitis C virus RNA in breast milk was significantly lower than in serum. Therefore, there is no scientific evidence that breastfeeding poses an additional risk to the baby. However, it must be remembered that viral infections such as HIV and human lymphocytic leukemia-lymphoma-1 (HTLV-1) can be transmitted through breast milk. A pregnant infected woman should know this and make her choice regarding breastfeeding.

Monitoring the health of the child after birth

The state of health of a child born from an infected mother must be monitored in the postnatal period. This will allow infected children to be identified, monitored and, if necessary, treated. IN ideal conditions this should be done by professionals experienced in the diagnosis and treatment of infectious diseases in young children. According to the authors, testing for anti-HCV and hepatitis C virus RNA should be performed at 1, 3, 6, and 12 months of age. The absence of hepatitis C virus RNA in all samples, as well as evidence of the decay of acquired maternal antibodies, is an accurate proof that the child is not infected. However, the interpretation of results in newborns must be done with great caution: the presence of hepatitis C virus RNA in the absence of a partial antibody reaction has been described in some children, suggesting that newborns may develop seronegative chronic hepatitis C infection. It is also believed that perinatal acquired hepatitis C infection There is no cure for C, and as a result, chronic hepatitis develops in most children. So far, there is no evidence that the use of immunoglobulin or antiviral drugs (interferon, ribavirin), for example, after blood is entered into the wound or in newborns, reduces the risk of infection. Unlike HIV-infected children, children born to mothers with positive reaction for hepatitis C are not necessarily subject to therapeutic intervention. Thus, infection with viral hepatitis C can be parenteral, acquired through sexual contact (although cases of infection are rare), or vertical, transmitted from mother to child. Therefore, it is important for obstetricians to be aware of this virus, especially its manifestations in pregnant women. Antenatal monitoring of the health of infected women during pregnancy should be specific, and caesarean section (at the mother's choice) should be considered as the mode of delivery. The risk of transmission of the virus through breastfeeding appears to be very low. The pediatrician should monitor the health of such a child, giving Special attention manifestations of infectious diseases. Therefore, a screening examination using informative diagnostic tools should be a prerequisite for building an effective system for the prevention and protection of maternal and child health.

Literature

Balayan M. S., Mikhailov M. I. Encyclopedic dictionary "Viral hepatitis". Moscow: Ampipress. 1999.
Boychenko M. N. Hepadnaviruses (family Hepadnaviridae, hepatitis B virus). Medical Microbiology, Virology and Immunology: Textbook / Ed. Vorobieva A. A. M.: MIA, 2004. 691 p.
Ignatova T. M., Aprosina Z. G., Shekhtman M. M., Sukhikh G. T. Viral chronic liver diseases and pregnancy // midwife. and gin. 1993. No. 2. S. 20-24.
Kuzmin V. N., Adamyan L. V. Viral infections and pregnancy. M., 2005. 174 p.
Malyshev N. A., Blokhina N. P., Nurmukhametova E. A. Guidelines. Viral hepatitis. Allowance for patients.
Onishchenko G. G., Cherepov V. M. On sanitary and hygienic well-being in Eastern and Western Siberia and measures to stabilize it, taken within the framework of the Siberian Agreement Association // Zdravookhraneniye Russian Federation. 2000. No. 2. S. 32-38.
Shekhtman M. M. Clinical and immunological variants of acute viral hepatitis and pregnancy // Gynecology. 2004, vol. 6, no. 1.
Yushchuk N. D., Vengerov Yu. Ya. infectious diseases. Medicine, 2003, 543 p.
Beasley R.P, Hwang L.-Y. Epidemiology of hepatocellular carcinoma, Vyas G. N., Dienstag J. L., Hoofnagle J. H. eds. Viral Hepatitis and Liver Disease. Orlando, FL: Grime & Stratton, 1984, pp. 209-224.
Berenguer M., Wright T. L. Hepatitis B and C viruses: molecular identification and targeted antiviral therapies // Proc Assoc Am Physicians. 1998 Vol. 110(2). P. 98-112.
Brown J. L., Carman W. F., Thomas H. C. The hepatitis B virus // Clin Gastroenterol. 1990 Vol. 4. P. 721-746.
Faucher P., Batallan A., Bastian H., Matheron S., Morau G., Madelenat P., Benifia J. L. Management of pregnant women infected with HIV at Bichat Hospital between 1990 and 1998: analysis of 202 pregnancies // Gynecol Obstet Fertil. 2001 Vol. 29(3). P. 211-25.
Hiratsuka M., Minakami H., Koshizuka S., Sato 1. Administration of interferon-alpha during pregnancy: effects on fetus // J. Perinat. Med. 2000 Vol. 28. P. 372-376.
Johnson M. A., Moore K. H., Yuen G. J., Bye A., Pakes G. E. Clinical pharmacokinetics of lamivudine // Clin Pharmacokinet. 1999 Vol. 36(1). P. 41-66.
Ranger-Rogez S., Alain S., Denis F. Hepatitis viruses: mother to child transmission // Pathol Biol (Paris). 2002 Vol. 50(9). P. 568-75.
Steven M.M. Pregnancy and liver disease // Gut. 1981 Vol. 22. P. 592-614.

V. N. Kuzmin, doctor of medical sciences, professor

GBOU VPO MGMSU of the Ministry of Health and Social Development of Russia, Moscow

For the first time, a person fell ill with the hepatitis C virus 300 years ago. Today in the world about 200 million people (3% of the total population of the Earth) are infected with this virus. Most people are not even aware of the presence of the disease, because they are latent carriers. In some people, the virus multiplies in the body for several decades, in such cases they talk about the chronic course of the disease. This form of the disease is greatest danger because it often leads to cirrhosis or liver cancer. As a rule, infection with viral hepatitis C in most cases occurs in young age(15-25 years).

Of all known forms, viral hepatitis C is the most severe.

The method of transmission occurs from person to person through the blood. Infection often occurs in medical institutions: during surgical operations during blood transfusion. In some cases, it is possible to become infected by household means, for example, through syringes from drug addicts. Sexual transmission is not excluded, as well as from an infected pregnant woman to the fetus.

Hepatitis C Symptoms

In many infected people, the disease does not make itself felt at all for a long period of time. At the same time, irreversible processes take place in the body, leading to cirrhosis or liver cancer. For such insidiousness, hepatitis C is also called the “gentle killer”.

20% of people still notice a deterioration in their health. They feel weakness, decreased performance, drowsiness, nausea, loss of appetite. Many of them are losing weight. There may also be discomfort in the right hypochondrium. Sometimes the disease manifests itself only with joint pains or various skin manifestations.

Detection of the hepatitis C virus in a blood test does not present any difficulties.

Hepatitis C treatment

There is currently no vaccine for hepatitis C, but it is possible to cure it. Note that the earlier a virus is detected, the greater the chance of success.

If a pregnant woman is infected with the hepatitis C virus, she must be examined for the presence of characteristic signs of chronic liver disease. After the baby is born, a more detailed hepatological examination is performed.

Treatment of hepatitis C is complex, and the main drugs used in the treatment are antiviral.

Fetal infection

In most cases, the hepatitis C virus does not have any negative effect on the course of pregnancy. In fact, the possibility of infecting a child with hepatitis C exists only in 2-5% of the total number of infected expectant mothers. If a woman is also a carrier of HIV, the risk of infection increases to 15%. In addition, there are a number of conditions and conditions under which it is possible to infect a child. Among them, first of all, hypovitaminosis, poor nutrition are distinguished. The bulk of cases when there is infection of the fetus with hepatitis C occurs at the time of delivery or the immediate postpartum period.

How to give birth?

It has been proven that the frequency with which the hepatitis C virus is transmitted from mother to child does not depend on whether the baby was born naturally or by caesarean section. There is a category medical workers, who argue that during a caesarean section, the risk of infection is less. Which way of delivery to choose in a particular case is up to the woman and her attending physician. In some cases, when the patient is also infected with other viruses (for example, hepatitis B or human immunodeficiency), a planned cesarean is recommended.

Child

During pregnancy, antibodies to hepatitis C are transmitted to the baby through the placenta. After birth, they can circulate in the blood for a year and a half, and this is not a sign that the baby was infected from the mother.

Examination of the child for possible infection during childbirth should be carried out at 6 months after birth (blood test for HCV RNA) and at 1.5 years (blood test for anti-HCV and HCV RNA).

Immediately after birth, doctors closely monitor the health of the newborn.

Breast-feeding

It is not forbidden, but it is necessary to ensure that the baby does not injure the mother's nipples, otherwise the risk of infection increases. It is believed that the benefits to the child's body from breastfeeding far outweigh the risk of contracting the virus. Mothers need to carefully monitor that sores and aphthae do not form in the child's mouth, since infection can occur through them during breastfeeding. If a woman is also infected with the human immunodeficiency virus, then breastfeeding is contraindicated.

Prevention of hepatitis C

In order not to get infected with the hepatitis C virus, you need to remember the following. In no case should you use other people's things: razors, toothbrushes, nippers for manicure and pedicure, nail files or other items that may come into contact with blood. If you have to use the services of a tattoo artist, make sure that the tools are properly sterilized. It is better if disposable needles are used for these purposes.

During sexual intercourse (especially promiscuity), you can reduce the risk of infection by using condoms.

Especially for- Elena Kichak

From Guest

Found antibodies to hepatitis C for 5 weeks. How many experiences were words beyond words. From ZhK they gave a referral to an infectious disease specialist. He laughed, made a diagnosis of "carrier of hepatitis C" and said "don't worry, you will give birth - then come." In LCD appointed analysis again. Negative.

From Guest

Today at the turnout they said that they might have found Hepatitis C ... there are signs that have not yet been fully identified. On December 30, they said they would say for sure .... here I sit and torture myself ... where did I get this from ... and I'm very nervous ... pregnancy 27 weeks

Viral hepatitis represent a fairly large group of diseases, the main etiological factor(cause) of which are various hepatotropic viruses with multiple transmission mechanisms.

Viral hepatitis is manifested mainly by damage to the liver and a violation of its normal functioning in the form of intoxication, dyspeptic syndromes, hepatomegaly - liver enlargement - and jaundice - yellow skin and mucous membranes.

The group of viral hepatitis, which is the most common and studied today, includes hepatitis A and B, hepatitis C, hepatitis D and E. The list of new discussed “candidates” for the role of hepatitis pathogens includes viruses F, G, SEN V, TTV. A rather serious problem today is the existence of mixed hepatitis - an association of several viruses.

hepatitis and pregnancy

The appearance in a pregnant woman of various disorders in the functioning of the liver can also be caused by pregnancy, or it can be caused by other reasons that only coincide with the development of pregnancy in time.

During the normal course of pregnancy, changes in the structure of the liver do not occur, but during this period, temporary disturbances in its functioning may develop. This is due to the reaction of the liver in response to a sharp increase in the load on it - in connection with the need to neutralize both the waste products of the fetus and the waste products of the mother at the same time.

In addition, during pregnancy from the first trimester, there is a significant increase in the level of hormones, including sex hormones, in the blood of a pregnant woman, and their exchange is also carried out in the liver.

The appearance of a temporary violation of the functioning of the liver in pregnant women may be manifested by a change in some biochemical indicators blood. Since the appearance of such changes is also characteristic of liver diseases, in order to diagnose them and the stability of the violation, it is necessary to conduct studies in dynamics, and it is recommended to repeatedly take tests and compare them with the state of the pregnant woman.

When returning after childbirth within 1 month of all the changed indicators to normal, the violation should be considered temporary and caused by pregnancy. If the normalization of the parameters is not noted, then this serves as a confirmation of hepatitis.

Classification of hepatitis

acute hepatitis A; fecal-oral route of transmission of infection (for example, along with water and food, dirty hands and household items contaminated with the feces of a sick person); can heal spontaneously without medical intervention. Hepatitis A is a “contagious” virus during the pre-icteric stage of the disease; after the onset of jaundice, the patient is not contagious: this indicates that the human body has coped with the causative agent of the disease. In the vast majority of cases, this type of viral hepatitis is not chronic, and there is no carriage of the virus, and people who have had AVH A have lifelong immunity;

acute hepatitis B and C- parenteral route of transmission of infection (for example, along with saliva, blood, vaginal secretions). The perinatal and sexual routes of infection transmission play a much less significant role. The disease is quite often chronic - acquires a chronic course. Asymptomatic course is typical for mild cases; other patients may also have mild manifestations of jaundice, but pronounced - from the gastrointestinal tract - gastrointestinal - intestinal tract, including even flu-like symptoms;

acute hepatitis D, or delta- parenteral route of transmission of infection (for example, along with saliva, blood, vaginal secretions), but only those people who are already infected with hepatitis B are affected. The association with acute hepatitis D aggravates the general course of the disease;

acute hepatitis E- fecal - oral route of transmission of infection (most often with water); is of particular danger to pregnant women, since the frequency of severe forms of infection when infected with this type of hepatitis is high;

chronic hepatitis B and C- Hepatitis, occupying about 70 - 80 percent of the entire spectrum of chronic hepatitis. Chronic hepatitis refers to those that continue without improvement for at least 6 months. As a rule, the development of pregnancy against the background of the presence of chronic hepatitis is a rare occurrence, which is associated with frequent menstrual dysfunction in women and, as a result, infertility.

The impact of hepatitis on pregnancy

acute hepatitis A- as a rule, it does not have a significant pronounced effect on the course of both pregnancy and childbirth, equally as on the development of the fetus - in most cases, the child is born healthy. At birth and after the baby is not at risk of infection, therefore, it does not need special prophylaxis. If the time of the disease falls on the second and third trimesters of pregnancy, then it is usually accompanied by a progressive deterioration in the general well-being and condition of the woman. Since the course of the disease can worsen childbirth, it is best to delay the term of childbirth until the end of jaundice;
acute hepatitis B and C- since there is some possibility that the virus will pass through the placenta, the risk and possibility intrauterine infection there is also a fetus; during childbirth, the risk of infection is much higher;
acute hepatitis D, or hepatitis delta- aggravates the course of hepatitis in a pregnant woman;
acute hepatitis E- a particularly dangerous virus for pregnant women, since the frequency of severe forms of the disease when infected with acute hepatitis E is high;
chronic hepatitis B and C- the development of pregnancy against the background of the presence of chronic hepatitis is a rare occurrence, which is associated with frequent menstrual dysfunction in women and, as a result, infertility. Moreover, the more severe the course of the disease, the higher the likelihood of developing infertility, since in the case of the development of chronic processes in the liver, a serious imbalance is observed in the ratio of sex hormones. If a pregnant woman suffers from chronic hepatitis, then already during the first trimester she is subject to hospitalization in a hospital for complete examination.

Symptoms of hepatitis in a pregnant woman

asthenoneurotic disorders (unmotivated fatigue, unmotivated weakness, irritability and bad dream, pain in the right hypochondrium);
dyspeptic disorders (vomiting, nausea, loss of appetite, impaired stool, increased gas formation in the intestines);
cholestatic disorders (the appearance of jaundice as a result of impaired bile secretion, the presence of skin itching).

Features of the treatment of hepatitis in pregnant women

During pregnancy, interferon treatment is not used, as it is potentially dangerous to the fetus.

Pregnant women who have recovered from acute viral hepatitis or those who suffer from chronic viral hepatitis in remission, in drug therapy dont need.

The main recommendations for them are to protect them from the effects of hepatotoxic - harmful to the liver - substances (alcohol consumption, inhalation of vapors of harmful chemical agents - varnishes, paints, automobile exhausts, combustion products of the use of drugs of the NSAID class - non-steroidal anti-inflammatory substances and some antibiotics, antiarrhythmic drugs) , adherence to a special diet rich in minerals and vitamins.

Pregnant women with acute viral hepatitis should give birth in specialized infectious diseases departments, and the question of the method of delivery used must be decided individually for each. In the absence of obstetric contraindications to conventional delivery, a woman should give birth on her own through the natural birth canal.

Application hormonal contraceptives women with hepatitis are contraindicated, since both their own hormones and hormones that come with the pill from the outside undergo “processing” - they are metabolized in the liver, and with hepatitis, its function is significantly impaired. In this regard, after the baby is born, you need to think about another method of contraception.

The impact of hepatitis on fetal development

The presence of severe hepatitis in a pregnant woman can adversely affect the development of the fetus, since a deep violation of liver function threatens the development of fetoplacental insufficiency due to circulatory disorders and the appearance of changes in the blood coagulation and anticoagulation systems. And although at present there is no clear answer to the question of the possibility of a teratogenic effect of hepatitis viruses on fetal development, the possibility of vertical
transmission from mother to fetus has been proven. When breastfeeding, the risk of infection of the newborn does not increase, it increases with damage to the nipples and / or the presence of erosions (other damage) of the mucous membrane oral cavity in a newborn.

Prevention of transmission of hepatitis to the newborn

Since the possibility of transmitting the hepatitis B virus to the child from the mother is great, the immunoprophylaxis of infection, which is carried out immediately after the birth of the child, plays an important role. Combined prophylaxis prevents the disease in 91 to 96 percent of cases in high-risk children. The question of the need for this event should be discussed in advance with the pediatrician.

Hepatitis is the general name for inflammatory diseases of the liver arising from various causes. As you know, the liver is an organ that plays important role in digestion and metabolism, or, in other words, the central organ of the chemical homeostasis of the organism. The main functions of the liver include the metabolism of proteins, fats, carbohydrates, enzymes, bile secretion, a detoxifying function (for example, the neutralization of alcohol), and many others.

Various disorders of the liver in a pregnant woman can be caused by pregnancy, and can only coincide with it in time. If the pregnancy proceeds normally, the structure of the liver does not change, but during this period there may be a temporary violation of its function. This violation occurs as a reaction of the liver to a sharp increase in the load on it due to the need to neutralize the waste products of the fetus. In addition, during pregnancy, starting from the first trimester, the content of hormones increases significantly, primarily sex hormones, the exchange of which also occurs in the liver. Temporary dysfunction in pregnant women can lead to changes in some biochemical parameters. Similar changes also appear during liver diseases, therefore, in order to diagnose the stability of the disorder, one should examine them in dynamics, repeatedly and compare them with physical condition pregnant. If within 1 month after birth all the changed indicators returned to normal, the violation was temporary, caused by pregnancy. If normalization is not observed, this may serve as confirmation of hepatitis. Viruses are the main cause of hepatitis.

Acute viral hepatitis

Viral hepatitis, and in particular acute viral hepatitis (AVH), are the most common liver diseases not causally related to pregnancy. Typically, the severity of viral hepatitis increases with increasing gestational age.

Currently, there are several variants of acute viral hepatitis.

Hepatitis A is transmitted by the fecal-oral route (with contaminated feces of a sick person with water, food, dirty hands, household items, etc.) and spontaneously, without the intervention of doctors, is cured. Viral hepatitis A is intestinal infections. It is contagious in the pre-icteric stage of the disease. With the appearance of jaundice, the patient ceases to be contagious: the body has coped with the causative agent of the disease. This type of viral hepatitis in the vast majority of cases does not turn into chronic form no carrier of the virus. People who have undergone AVH A acquire lifelong immunity. Usually hepatitis A does not have a significant impact on the course of pregnancy and childbirth, on the development of the fetus. The baby will be born healthy. It is not at risk of infection and does not need special prophylaxis. If the disease occurred in the second half of pregnancy, then it is usually accompanied by a deterioration general condition women. Childbirth can worsen the course of the disease, therefore it is desirable to delay the term of labor until the end of jaundice.

Hepatitis B and C are transmitted parenterally (i.e. through blood, saliva, vaginal discharge etc.). Sexual and perinatal routes of transmission play a much less significant role. Often the disease becomes chronic. In mild cases, the attack of the virus is asymptomatic. In other patients, jaundice may also be absent, but there are complaints from the gastrointestinal tract, flu-like symptoms. The diagnosis can be difficult even to suspect if there is no evidence of possible infection with hepatitis viruses. The severity of the disease, accompanied by jaundice, can be different - from the form when the disease ends in complete recovery, and to its chronic course. There is some possibility of passing the virus through the placenta and, accordingly, the possibility of intrauterine infection of the fetus. The risk of infection increases significantly during childbirth.

Hepatitis D(delta) is also transmitted parenterally and only affects people already infected with hepatitis B. As a rule, it aggravates the course of hepatitis.

Hepatitis E It is spread, like hepatitis A, by the fecal-oral route, and the source of infection is usually contaminated water. This virus is especially dangerous for pregnant women, because when infected with it, the frequency of severe forms of the disease is high.

In general, the clinical course of AVH A, B and C is similar, although hepatitis B and C are more severe.

chronic hepatitis

In the International Classification of Liver Diseases, chronic hepatitis (CH) is defined as an inflammatory disease of the liver caused by any cause and lasting for at least 6 months without improvement. Up to 70-80% of all chronic hepatitis are hepatitis of viral etiology (hepatitis B and C viruses). The rest is accounted for by autoimmune toxic (for example, medicinal) and alimentary (in particular, alcoholic) hepatitis. Pregnancy against the background of chronic hepatitis is rare, this is largely due to menstrual dysfunction and infertility in women with this pathology. The more severe the disease, the higher the likelihood of infertility. This is explained by the fact that the liver is an organ involved in the metabolism of hormones, and in chronic processes in the liver there is a serious imbalance in the concentration and ratio of sex hormones. As a result, there is a lack of ovulation (the release of an egg from the ovary) and normal menstrual cycle. However, in some cases, doctors manage to achieve remission of the disease, restoration of menstrual function and the ability to bear children. However, only the therapist can give permission to continue the pregnancy. antenatal clinic or a hepatologist after a thorough comprehensive examination of the woman. Therefore, a pregnant woman suffering from CG should be hospitalized in a hospital in the first trimester, where there is an opportunity for a complete examination. The degree of activity and stage of CG outside of pregnancy are determined by a morphological examination of a liver biopsy. Liver biopsy is not performed in pregnant women in our country, so the main diagnostic methods are clinical (based on the analysis of the woman's complaints and her life history) and laboratory.

Diagnostics

Main Clinical signs hepatitis in pregnant women, as well as in non-pregnant women, are of the same type and include a number of syndromes:

dyspeptic (nausea, vomiting, loss of appetite, stool, increased gas formation in the intestines),
asthenoneurotic (unmotivated weakness, fatigue, poor sleep, irritability, pain in the right hypochondrium),
cholestatic (jaundice due to impaired bile secretion, skin itching).

These symptoms can also occur during a more or less normal pregnancy without hepatitis, so do not diagnose yourself ahead of time, but contact your doctor with complaints so that he, in turn, understands the causes of these conditions. Do not self-medicate, because all the same, before the examination, hepatitis cannot be completely excluded, and you will lose precious time. If AVH is suspected, the doctor will definitely try to find out if there was a possibility of infection by asking about contacts, recent travel, injections and operations, blood transfusions, dental treatment, tattoos, piercings, eating unwashed vegetables, fruits, raw milk, mollusks (4 epidemics of AVH A have been described due to the consumption of raw mollusks and oysters from contaminated reservoirs).

To resolve the issue of possible viral damage to the liver, to determine the type of virus and the stage of the disease, it becomes necessary to conduct special tests. One of them is a blood test for the presence of the HBs antigen (HBs - Ag 2 ). HBs antigen is enough reliable sign infection with the hepatitis B virus. Since hepatitis B is a widespread infection, which is not only a serious problem for a pregnant woman and her child, but also potentially dangerous for people in contact with her, there was a need for mandatory testing for this virus.

During pregnancy, a mandatory three-time blood test for the detection of HBs antigen has been decreed. In the absence of a negative analysis during the last three months before delivery or during positive study on HBs - Ag, a pregnant woman, as a rule, cannot give birth in the same birth block with uninfected women in labor. This frequency of testing is associated with the possibility false negative results, as well as with the likelihood of infection already during pregnancy as a result of injections, treatment at the dentist, etc.

Since in diagnosing the activity (aggressiveness) of chronic hepatitis during pregnancy, doctors cannot resort to a biopsy, as the most reliable diagnostic method, this indicator is determined by a several-fold increase in the level of aminotransferases (alanine ALT and aspartic AST) - enzymes that enter the bloodstream when breakdown of liver cells. The degree of their activity corresponds to the intensity inflammatory process in the liver and is one of the main indicators of the dynamics of the course of hepatitis. Therefore, the doctor may recommend conducting repeated biochemical blood tests. It should be remembered that blood must be donated in the morning on an empty stomach after a 12-14 hour fast. An ultrasound examination of the internal organs helps in diagnosing the stage of hepatitis.

Treatment

Medical therapy in last years has undergone significant changes. For the treatment of viral hepatitis, almost the only group of etiotropic drugs, i.e. directed directly against the virus, actions with proven effectiveness are interferons. Interferons were discovered in 1957. They are a group of proteins synthesized by human leukocytes in response to exposure to a virus. They can be called antiviral antibiotics. However, during pregnancy, this type of therapy is not used, which is associated with a potential hazard to the fetus. Treatment with other groups of drugs is carried out strictly according to the doctor's prescription.

Pregnant women who have recovered from AVH or who suffer from CVH in remission do not need drug therapy. They should be protected from exposure to hepatotoxic substances (alcohol, chemical agents - varnishes, paints, automobile exhausts, combustion products, and others, from drugs - non-steroidal anti-inflammatory substances, some antibiotics, some antiarrhythmic drugs, etc.). They should avoid significant physical exertion, overwork, hypothermia. You should adhere to 5-6 meals a day, observing special diet(the so-called table number 5). Food should be rich in vitamins and minerals.

A pregnant woman suffering from chronic hepatitis should be remembered that the favorable course of the disease in some cases can turn into severe at any time, so she must strictly adhere to all the advice of her doctor.

Women with acute viral hepatitis give birth in special infectious diseases departments. Pregnant women suffering from hepatitis of non-viral etiology, not representing a potential danger, are in maternity hospitals in the department of pathology of pregnant women.

The question of the method of delivery is decided individually. If there are no obstetric contraindications for conventional delivery, then, as a rule, a woman gives birth herself, through the natural birth canal. In some cases, doctors resort to caesarean section.

Hormonal contraception is contraindicated for women suffering from hepatitis, since both their own hormones and hormones introduced from the outside with a contraceptive tablet are metabolized in the liver, and its function in hepatitis is significantly impaired. Therefore, after the birth of a child, you should think about another, safe, method of contraception.

It should be said that the presence of severe hepatitis in a pregnant woman can adversely affect the development of the fetus, since with a deep violation of liver function, fetoplacental insufficiency develops due to circulatory disorders, changes in the blood coagulation system. Currently, there is no clear answer to the question of the teratogenic effects of hepatitis viruses on the fetus. The possibility of vertical (from mother to fetus) transmission of the virus has been proven. Breast-feeding does not increase the risk of infection of the newborn, the risk increases with damage to the nipples and the presence of erosions or other damage to the oral mucosa of the newborn.

Due to the possibility of transmission of hepatitis B virus from mother to child great importance has immunoprophylaxis of infection, carried out immediately after the birth of a child. Combined prophylaxis in 90-95% of cases prevents the disease in high-risk children. The need for such measures a woman should discuss with the pediatrician in advance.