Hepatitis B and C in Pregnancy: Well Within Our Scope

[Pages:65]Hepatitis B and C in Pregnancy: Within Our Scope

Joseph Breuner, MD Clinical Associate Professor of Family Medicine, University of Washington Swedish Family Medicine Residency and Obstetrics Fellowship Faculty March 25, 2022

Learning Objectives

1. Evaluate screening management and treatment recommendations for hep b and c in pregnancy

2. Explore prophylaxis for hep b for infants born to mothers with chronic active hepatitis b

3. Identify appropriate candidates for treatment of hep b infection during pregnancy

4. Discern chronic active hepatitis b patients with cirrhosis who are at higher risk of multiple complications.

5. Review referral guidelines for patients with cirrhosis at increased risk of decompensating during pregnancy.

outline

Case Hep b

Hep b in pregnancy

Case Hep c

Hep c in pregnancy

Case Newborn prophy Breastfeeding Case

General Approach

Identify infection. Universal screening in pregnancy Assess fibrosis of liver. F0-F4. Decompensated cirrhosis

requires referral Treat infection. During pregnancy for Hep B, before or after

pregnancy for Hep C until glecapravir/pibrentasvir (G/P) approved in pregnancy. HCC surveillance for all patients with cirrhosis and a few others

Practice Recommendations

1. Screen all pregnant patients for Hep B and Hep C. Treat Hep B if viral load >200k. Coming soon: treat Hep C

2. Prophylax newborns of moms with chronic active Hep B. Hepatitis B vaccine and Hepatitis B Immune Globulin within first 12 hrs of life.

3. Candidates for treatment Hep B in pregnancy: viral load >200k 4. Discern chronic active Hep B patients with cirrhosis at higher

risk of complications. Develop your fibrosis staging strategy. 5. Identify and refer patients with decompensated cirrhosis:

ascites, encephalopathy, or esophageal varices.

Case

35 yo from ethiopia In US since 2018 Moved to seattle 2020 G2P0010

Case

Pregnancy symptoms: yes breast tenderness no fatigue no constipation Yes nausea and vomiting every morning.

No headache, vision changes, abdominal pain

No vaginal bleeding. No abdominal or pelvic pain

Case

First pregnancy: Elective termination around 2 months in 2014-15

- Prior c-section? No - Prior preterm delivery ( ................
................

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