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PREGNANCY
DR. OTOGIE EDISENIMI
MBBS, MADONNA UNIVERSITY
OUTLINE
Introduction
Epidemiology
Route of transmission
Factors influencing vertical transmission
Clinical features
Investigations
Risk of perinatal transmission
Interventions/treatment
Prevention
Conclusion
References
INTRODUCTION
PRECONCEPTION
Vaccination of all women of reproductive age with the vaccine.
Reduce the viral load of infected women to a minimum level before
conception.
IN-UTERO
Do routine HBsAg for all pregnant women coming for ANC registration
When a positive result is gotten, the woman should be adequately
counseled and a 5- panel test + Viral load testing is done.
Husband and close relatives are also counseled, tested and
vaccinated where need be.
At 32weeks with viral load >1000000000 copies/ml, the woman is placed
on antiviral like lamivudine 100mg/day for 1month. This reduces viral
load from 28 to 12.5% thereby reducing risk of peri partum transmission.
INTERVENTION/TREATMENT
LABOUR
When in labour, modified obstetric practices are strictly adhered to
they include;
Avoid External cephalic version
Avoid Multiple vaginal examinations
Avoid Artificial rupture of membranes or delay ARM
Avoid Episiotomy as much as possible
Ensure early cord clamping
Avoid milking of the cord
Avoid vigorous suctioning
FOLLOWING DELIVERY
Baby is placed on post exposure prophylaxis which will involve;
HBIG 0.06mls/kg within 24-48hrs of delivery. It gives protection for 3-
6months as an adjunct to HB vaccine.
HB vaccine which contains HBsAg in attenuated form. It is given IM
and can be given simultaneously with other vaccines. It is given in 3
divided doses.
BREATFEEDING AND INFECTIVITY
Traces of the virus can be found in the breast milk but breastfeeding is not
contraindicated in babies on post exposure prophylaxis.
BEFORE DISCHARGE
Parents are counseled on risk of transmission of infection from use of
sharps, blood transfusion and scarification marks.
PREVENTION
PRIMARY LEVEL
ANC Attendance.
Use of vaccine in women of reproductive age.
Ensure HBsAg testing during pregnancy.
SECONDARY LEVEL
Treatment with antivirals to reduce viral load.
Modified obstetric practices.
Post exposure prophylaxis.
TERTIARY LEVEL
Prompt identification and treatment of complications.
CONCLUSION
SMS OBSTETRICS
CURRENT OBSTETRICS AND GYNAECOLOGY
MEDSCAPE
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