Hepatitis C in pregnant women. Hepatitis C and pregnancy

Each gynecologist advises women to plan pregnancy in order to be able to treat all identified diseases before it occurs, normalize the state of immunity, and strengthen the body by taking it. Hepatitis C is a serious disease. Therefore, patients with such a diagnosis should have information about how it can affect the course of pregnancy and fetal development.

Pregnancy and hepatitis

In itself, this disease is not a contraindication to conception. However, in chronic hepatitis, the question arises of maintaining the pregnancy that has occurred.

When a healthy woman is infected, the disease can be defeated with medications within six months. If the virus has not left the body during this period, then hepatitis has certainly passed into the chronic stage. And it is fraught with gradual destruction of the liver.

Symptoms of the disease in expectant mothers may appear slightly or not at all. The woman simply does not pay attention to them. But the disease requires treatment, because it is fraught with cirrhosis or liver cancer. Primary infection is manifested by weakness, deterioration in performance, and may be similar to the initial signs of influenza. By the way, rarely causes jaundice.

The chronic nature of the disease during pregnancy can be manifested by nausea, muscle pain, increased fatigue, pain in the liver, and increased anxiety.

Treatment of hepatitis C in expectant mothers

When carrying a child, it is forbidden to take medications to combat the disease. After all, traditional drugs (and this is interferon and ribavirin) are dangerous for the fetus, because they can provoke malformations. Patients should be protected from hepatotoxic effects. These are varnishes, paints, alcohol, automobile exhausts, combustion products.

It is forbidden to take antibiotics, non-steroidal anti-inflammatory drugs, antiarrhythmic drugs. Overwork, physical activity, hypothermia are contraindicated for women. A pregnant woman should eat fractionally, 5-6 times a day.

Future mothers with such a diagnosis give birth in infectious diseases departments. The method of delivery is chosen by the observing obstetrician-gynecologist together with the therapist.

How does hepatitis C during pregnancy affect the fetus?

In such a patient, the baby may be born prematurely, while underweight. He will need special care. If hepatitis in a future mother is combined with obesity, then the chances of development increase several times. There is also a constant threat of fetal hypoxia, miscarriage.

As for the transmission of the virus from mother to baby, then during the period of gestation and during childbirth, such a probability is low. Statistics show that this happens in five cases out of a hundred. But the chance of transmission will increase if the pregnant woman has HIV.

After the baby is born, it is mandatory to conduct a study for the presence of the disease. It is worth knowing that the presence of the virus in his blood for 18 months is not considered a sign of hepatitis, since the antibodies are of maternal origin. When in a year and a half the test results confirm the breakdown of maternal antibodies, it can be argued that the baby is healthy.

The illness of the mother does not affect breastfeeding, because the virus is not transmitted to the baby with mother's milk. But the risk of infection exists when the mother's nipples are damaged or the baby has damage in the oral cavity. It is worth noting that the conception of a child with a chronic form of hepatitis C occurs in rare cases. After all, this disease disrupts the menstrual cycle and often leads to infertility.

Unfortunately, there is no vaccine against this type of hepatitis. But you can get vaccinated against its other forms - A and B. Such a need arises at a high risk of infection. Then, after vaccination, a woman is injected to increase immunity.

Pregnancy is a big responsibility, a serious step in a woman's life. Therefore, such a stage must be planned and conscious in order to be able to eliminate all risks, properly prepare the body, and protect it from infection with infectious diseases.

Diseases of a pregnant woman can negatively affect not only her health, but also the development of the baby. And hepatitis B during pregnancy is a very dangerous disease that requires special control and attention from doctors. Therefore, it is important to register at the antenatal clinic as soon as possible and undergo a full examination, which will indicate the presence or absence of a disease in a pregnant woman, in order to competently build a plan for observation or treatment with doctors.

Hepatitis B is a serious disease that poses a serious problem throughout the world due to the continuous increase in the number of cases, as well as the fairly frequent development of complications in the form of cirrhosis of the liver, carcinoma, and chronic or active form of the disease.

The incubation period of the disease lasts an average of 12 weeks, but in some cases it can range from 2 months to six months. From the moment the virus enters the bloodstream, its active reproduction begins. Hepatitis B has an acute and chronic form of the disease. The latter is not curable - a person will have to live with it throughout his life, and the acute one can be treated and a full recovery occurs with the development of stable immunity to this virus.

According to statistics, out of a thousand pregnant women, up to 10 women suffer from a chronic and 1-2 acute form of the disease.

Hepatitis B is an infectious disease, so during pregnancy it carries the risk of vertical transmission of the infection - from mother to child. In most cases, infection does not occur in utero (the probability of this is very low - about 3-10% of cases), but at the time of birth, as there is contact with infected blood and cervical secretions. When infected during pregnancy or childbirth, the child has a high chance of becoming a chronic carrier of the virus. In young children, the probability of the transition of the disease to a chronic state reaches 95%, while, having become infected in adulthood, the vast majority of patients recover.

How does infection occur?

Group B hepatitis is transmitted from an infected person through the blood.

The most common modes of transmission of the virus are:

Blood transfusion. Due to the fact that this method has a high probability of infection with hepatitis B (up to 2% of donors are carriers of the disease), blood is checked for the presence of the virus before the infusion procedure.
The use of non-sterile needles, manicure supplies and other things that could have left blood (even when dried). The use of one syringe needle by several people is the most common way of infection among drug addicts.
Sexual contact. Every year this route of infection is becoming more common.
From mother to child. Infection can occur both in utero and at the time of passage of the birth canal. The probability of infection is especially high if an active virus or its acute form is found in the mother.

It is not always possible to reliably find out exactly how the infection occurred - in about 40% of cases, the method of infection remains unknown.

Symptoms of the disease

If the disease was acquired before pregnancy occurred or the woman found out about it, then the presence of hepatitis B is usually recognized when taking blood tests immediately after registration. An analysis for this disease is mandatory during pregnancy, it is carried out at the first examination of a woman, and if it turns out to be positive, this is not necessarily an indicator of chronic hepatitis.

A positive test result is a reason to seek advice from a hepatologist, who, after a certain examination, can determine whether the virus is active. If the activity of the virus is confirmed, then treatment is required, which is contraindicated in pregnancy, since antiviral drugs affect the fetus. And since the risk of intrauterine infection is not high, the woman’s condition is monitored until delivery, and the child is vaccinated against hepatitis B immediately after birth.

Chronic hepatitis B (CHB) during pregnancy and without it in most cases is completely asymptomatic, so it is important to undergo an examination to detect the disease. And the acute form of the disease has an incubation period of 5 weeks to six months and can manifest itself with symptoms such as:

Nausea and vomiting (they are the main sign of toxicosis, therefore, they can indicate hepatitis only in combination with other symptoms);
General weakness associated with lack of appetite and fever;
Change in the color of urine (it becomes significantly darker than usual - dark yellow);
Light feces;
Pain in the joints;
An increase in the volume of the liver;
Abdominal pain or discomfort in the right hypochondrium;
Yellowness of the skin and eyes that are visible to the naked eye;
Fast fatiguability;
sleep disorders;
In some cases, confusion.

Read also related

Folk methods in the treatment of hepatitis C

If a pregnant woman discovers such symptoms in herself after receiving negative test results in the first half of pregnancy, it is imperative to tell her gynecologist about this and undergo an examination by a hepatologist. This will help reduce the chance of complications, as well as reduce the risk of infection of the baby during childbirth.

Childbirth with hepatitis

If hepatitis B is detected, then a woman has a reasonable question - how does childbirth occur in this case. Since the risk of infection of the fetus reaches 95% during natural delivery due to close contact with infected blood and vaginal secretions of the mother, doctors recommend a caesarean section, as this somewhat reduces the likelihood of transmitting the virus to the child. The risk of infecting a child directly depends on the activity of the virus - the lower it is, the more likely it is to give birth to a healthy baby.

The birth of a woman with such a disease takes place in special infectious maternity hospitals, where special conditions have been created for receiving patients with hepatitis and other viruses. If there are no such hospitals in the city, childbirth is carried out in the maternity wards of the infectious diseases hospital with the provision of a separate box or ward for the woman in labor.

Hepatitis B is not a contraindication for breastfeeding, contrary to the opinion of most women. An important condition is to maintain the integrity of the nipples - if cracks form, you should refrain from feeding (in this case, you should not give the child expressed milk, into which blood could get).

What to do if hepatitis B is detected during pregnancy?

Diagnosis of the disease during pregnancy is carried out three times by analyzing HBsAg. In the case of a positive test, they usually take the analysis again to exclude a false result. If hepatitis B is confirmed during pregnancy, the woman is sent to see a hepatologist. He conducts a more complete examination to identify the form of the disease (chronic or acute) using enzyme immunoassay and the condition of the liver by performing ultrasound. The doctor also gives advice on childbirth and the course of pregnancy. When an illness is detected in a woman, it is necessary to undergo an analysis for HBsAg for her partner, as well as for all family members.

“The hepatitis B virus is quite resistant to high and low temperatures, for example, at +30⁰С it retains its infectious activity for up to six months.”

Especially dangerous is acute hepatitis B in pregnant women, as there is a very large load on the liver. When infected during this period, the disease develops very quickly, which is fraught with complications, so a visit to a hepatologist is a prerequisite for a positive analysis. The chronic form of the disease is rarely manifested by exacerbations during pregnancy, its danger is only in the possible infection of the child.

Treatment and possible complications

Treatment of hepatitis B during pregnancy differs significantly from therapy at other times. All antiviral drugs that solve the problem of this disease have a teratogenic effect, that is, they lead to the occurrence of intrauterine fetal pathologies. Therefore, the period of bearing a child postpones antiviral therapy until childbirth, with the exception of situations with the appearance of inflammation in the liver, confirmed by ultrasound. During pregnancy, a doctor may prescribe hepatoprotectors to maintain the normal functioning of the liver. Which of these drugs to use is prescribed by the attending physician, depending on the characteristics of the woman and her condition. Vitamin therapy may also be prescribed.

During this period, observation and control tactics are used to treat hepatitis. Therapy of the disease during pregnancy is aimed at minimizing the likelihood of complications. All women with this virus are prescribed mandatory bed rest until childbirth. Hospitalization is not required if the condition of the pregnant woman is stable. Any kind of physical activity should be significantly limited.

It is also important to follow a certain diet throughout pregnancy, as well as after it. Such nutrition is aimed at maintaining the functioning of the liver and consists of the following principles:

The diet lasts at least 1.5 years;
Nutrition must be fractional 5 times a day with an interval between meals of about 3 hours;
The daily ration should not exceed 3 kg of food, and for people who are obese or close to it - 2 kg;
The calorie content of the diet should not exceed 2500-3000 kcal;
Restriction of salt intake;
A sufficient amount of liquid, not exceeding 3 liters;
Exclusion of fried, smoked and any canned foods;
Exclude fatty foods; it is forbidden to use pork and lamb for cooking;
Prohibited foods also include all legumes, mushrooms, spicy spices, fresh pastries (you can eat yesterday's bread), mushrooms, fried or hard-boiled eggs, sour cottage cheese, sweet foods, coffee;
Alcohol is strictly prohibited.

The hepatitis C virus was first discovered in 1989. Since then, the number of patients with this type of hepatitis has been progressively increasing. In developed countries, the prevalence of the virus is about 2%. One can only guess about the epidemiological situation in the third world countries of Africa or Asia. Many women of reproductive age become infected with hepatitis C through unprotected sex, cosmetic procedures, tattooing, and non-sterile medical interventions. Increasingly, it is detected in pregnant women. A reasonable question arises: is it possible for such patients to give birth to children?

Features of the virus

Hepatitis C is a viral liver disease. The infectious agent is an RNA-containing hepatitis C virus or HCV from the flavivirus family. A brief description of this virus and the disease it causes:

The virus is fairly stable in the environment. Studies show that the virus can survive in dried form from 16 hours to 4 days. This is its difference from, for example, the HIV virus, which is absolutely unstable outside the body.
The virus is quite variable, mutates extremely quickly and masks itself from the human immune system. For this reason, a vaccine against hepatitis C has not yet been invented. There is a vaccination against hepatitis B, which is included in the mandatory vaccination calendar of most countries.
It is hepatitis C that is called the “gentle killer”, because it rarely gives a picture of an acute disease, but immediately acquires a chronic course. Thus, a person can be a carrier of the virus for many years, infect other people and not be aware of it.
The virus does not directly infect liver cells, but "tunes" the immune system against them. Also, patients with this type of hepatitis are allocated to the risk group for malignant neoplasms of the liver.

Ways of infection

The hepatitis C virus is transmitted:

Parenterally, that is, through the blood. The reasons for this may be medical manipulations, manicure, pedicure, tattooing, transfusion of infected donor blood. Injection drug addicts, as well as medical workers, are identified as risk groups.
Sexually. Homosexuals, sex workers and people who frequently change sexual partners are identified as a special risk group.
The vertical route of transmission, that is, from an infected mother to her child, through the placenta during pregnancy and through blood contact during childbirth.

Clinic and symptoms

As already mentioned, hepatitis C often has a latent, asymptomatic course. Very often, patients do not have an acute phase of hepatitis and icteric forms. In the classic version of acute hepatitis C, patients will complain of:

yellowing of the skin, mucous membranes and sclera of the eyes;
nausea, vomiting;
heaviness in the right hypochondrium;
weakness, sweating, sometimes fever;
itching of the skin.

Unfortunately, often only one of these symptoms is present, or the illness begins like a flu or a cold. The patient does not seek medical help, forgets about the episode of weakness or fever, and the "gentle killer" begins his destructive work.

With a long course of chronic hepatitis C, patients may complain of:

periodic weakness;
nausea, appetite disorders, weight loss;
periodic feeling of heaviness under the right rib;
bleeding gums, the appearance of spider veins.

Often the disease is detected absolutely by chance, for example, when taking tests for a planned operation. Sometimes the doctor prescribes a routine biochemical blood test to the patient and finds a high level of liver enzymes there. It is for reasons of the latent course of the disease that examination for hepatitis C and B is included in the mandatory lists of "pregnant" tests.

Diagnostics

A blood test for the content of antibodies to hepatitis C - antiHCV. This analysis shows the response of the human immune system to the introduction of the virus.
PCR or polymerase chain reaction has become in recent decades the "gold standard" for diagnosis and evaluation of the quality of treatment. This reaction is based on the detection of literally single copies of the virus in human blood. Quantitative PCR allows you to estimate the number of copies in a given volume of blood, which is actively used in determining the activity of hepatitis.
A biochemical blood test with an assessment of liver enzymes: AST, ALT, GGTP, bilirubin, CRP allows you to determine the activity of hepatitis and liver function.
Ultrasound of the liver allows you to assess its structure, the degree of tissue degeneration, the presence of cicatricial changes and vascular changes.
Liver biopsy and histological examination. In this case, a fragment of the liver is examined under a microscope to assess tissue degeneration and exclude malignant processes.

Features of the management of pregnant women with hepatitis C

Let's start with the fact that hepatitis C and pregnancy is a huge list of controversial issues that make the best infectious disease specialists and obstetricians in the world doubt. The article gives only introductory aspects of this disease. Independent interpretation of analyzes and the use of any medications is unacceptable!

In the vast majority of cases, we are dealing with chronic hepatitis C in a pregnant woman. This may be hepatitis that a woman treated and observed before pregnancy, or first detected during pregnancy.

The first option is easier. Very often, such patients are registered with an infectious disease specialist, are observed for a long time, and undergo periodic courses of treatment. Having decided to give birth to a child, the patient informs the attending physician about this. The infectious disease specialist selects a pre-gravid preparation scheme and allows the woman to become pregnant. When the long-awaited pregnancy has come, such patients continue their observation with an infectious disease specialist until the very birth.
Newly diagnosed hepatitis C during an existing pregnancy can be difficult. In some cases, it is associated with other types of hepatitis, with the human immunodeficiency virus. Often such pregnant women have highly active forms of hepatitis, liver dysfunction, secondary complications.

The course and prognosis of pregnancy entirely depend on:

Hepatitis activity. It is estimated by the number of copies of the virus in the blood (PCR method) and biochemical parameters of the blood.
The presence of concomitant infectious diseases: toxoplasmosis, HIV, hepatitis B, D.
The presence of secondary specific complications of hepatitis: cirrhosis of the liver, portal hypertension, varicose veins of the esophagus and stomach, ascites.
The presence of concomitant obstetric pathology: aggravated obstetric history, uterine fibroids, CI, inflammatory diseases of the pelvic organs, etc.
Lifestyle of a woman: dietary habits, working conditions of alcoholism, drug addiction, smoking.

Pregnant women with hepatitis C are identified by obstetricians as a separate risk group, since even with a successful pregnancy and low virus activity, the following complications occur:

Vertical transmission of the virus to the fetus. According to various sources, the probability of infection of the fetus during pregnancy ranges from 5% to 20%. Such different data depend on the woman's viral load and the characteristics of the course of pregnancy (whether there were obstetric manipulations, placental abruption). The main probability of infection of the child still falls on the period of childbirth.
Spontaneous miscarriages.
premature birth.
Fetoplacental insufficiency, intrauterine fetal hypoxia.
Fetal growth retardation, the birth of small children.
Premature discharge of amniotic fluid.
Obstetric bleeding.
Hepatosis of pregnant women, intrahepatic cholestasis.

Pregnant women are conducted according to special protocols, which include:

Joint supervision of an obstetrician and an infectious disease specialist.
Periodic monitoring of viral load and liver function. On average, a pregnant woman monthly takes a biochemical and general blood test. It is advisable to control the viral load at registration, about 30 weeks of pregnancy and on the eve of childbirth at 36-38 weeks.
According to indications, ultrasound of the liver, fibrogastroscopy, tests for blood clotting are performed.
During pregnancy, a mandatory diet is indicated to facilitate the work of the liver, prophylactic intake of iron preparations, hepatoprotectors (Hofitol, Artichol, Ursosan, etc.). In many cases, it is advisable to take drugs to improve placental blood flow (Actovegin, Pentoxifylline, Curantil).
Special antiviral treatment during pregnancy is usually not carried out due to insufficient knowledge of the effect of antiviral drugs and interferons on the fetus. However, in severe hepatitis and a high risk of infection of the fetus, the use of ribavirin and interferons is acceptable.
Mandatory antenatal hospitalization in a special department is expected to resolve the issue of the method of delivery. With a relatively favorable course of pregnancy, the patient goes to the hospital at 38-39 weeks.

Methods of delivery and breastfeeding

To this day, the issue of how it is safer to give birth to women with hepatitis C remains controversial. A number of studies have been conducted in different countries on the dependence of child infection on the method of delivery. The results are quite controversial.

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 the most dangerous, as it often leads to cirrhosis or liver cancer. As a rule, infection with viral hepatitis C in most cases occurs at a 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. Often, infection occurs in medical institutions: during surgical operations, during blood transfusions. 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 of medical workers who claim 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.

Specially 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.