Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy

BACKGROUND: Reports of obstetric complications of mothers infected with hepatitis C virus (HCV) are limited and the risk of mother-to-infant transmission varies widely. We assessed the course of pregnancy in HCV-infected women and the rate of vertical transmission. METHODS: Between October 1992 and December 1996, 3712 pregnant patients of the university hospital Grosshadern Munich, Germany, were screened for anti-HCV and analyzed for HCV-RNA by polymerase chain reaction. Clinical and biochemical parameters were monitored. Children born to HCV-positive women were followed up at 6, 12 and 18 month intervals and screened for anti-HCV and HCV-RNA. RESULTS: Thirteen (42%) of 31 anti-HCV positive patients had a cesarean section which was twice the rate of that in the HCV-negative group (p=0.004). None of the cesarean deliveries was due to complications directly caused by HCV infection. Nine (29%) of 31 anti-HCV positive women had preterm delivery compared to 19% in the anti-HCV negative patients, the difference being statistically not significant. Fetal outcome parameters such as APGAR score, umbilical pH and birth weight of HCV infected pregnancies were not impaired. All 29 babies tested for anti-HCV were seropositive after birth. Between 12 and 18 months of age, 10% of the infants still were anti-HCV positive, whereas only one baby was HCV-RNA positive beyond 12 months yielding a vertical transmission rate of 5% among HCV-RNA positive mothers. CONCLUSION: Anti-HCV positive pregnancies have an increased risk of cesarean delivery, probably due to the high-risk collective of anti-HCV positive mothers. The mother-to-child transmission rate is low and linked to maternal HCV-RNA positivity.     

Maternal hepatitis C (HCV) infection and Anti-D immunoglobulin therapy: study testing antibodies,RNA and Genotype of HCV in Baghdad

Introduction: Hepatitis C virus (HCV) infection is a serious health problem. It is a major contributor to end-stage liver disease. Worldwide, 1–8% of all pregnant women were infected. Women with viral hepatitis may be at an increased risk of pregnancy complications. There are several obstetrics intervention acts as risk factors, which are specific to women pertaining the HCV infection; anti-D immunoglobulin (Ig) therapy may be one of them. Our objectives were to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy.

Materials and methods: A cross sectional study was conducted. A sample of 154 Rhesus negative (Rh???ve) pregnant women regardless of the anti-D Ig therapy was collected. Anti-HCV were tested using third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia Tek-111), subsequently. In addition, 89 serum samples were subjected to molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) method for the detection of HCV-RNA and genotypes.

Results: Anti-HCV, and HCV-RNA seroprevalence were significantly higher (17.1, 35.5%) among women with anti-D Ig than their counter group (6.4, 13.16%), p?=?.038, .018, respectively. Significant direct positive dose response correlation (r?=?0.78, p?=?.005) had been seen between number of anti-D Ig therapy and anti-HCV seropositive rate. Anti-D Ig therapy act as a risk factor (odds ratio (OR)?=?3.01, 95%CI: 1.01–8.9) especially from the third dose onward. Women with anti-D Ig therapy were at higher risk (3.6 times more) of positive HCV-RNA (OR =3.6, 95%CI =1.19–10.837). Genotype HCV-1b showed higher prevalent (52.9%) among the recipients of anti-D Ig therapy while genotype HCV-3a (6.6%) was the lowest.

Conclusions: Our study showed that Anti-D immunoglobulin therapy acts as a risk factor for acquiring HCV infection. Screening for HCV should be recommended for all recipients of anti-D Ig. Not only HCV antibodies but HCV-RNA detection being recommended for the diagnosis of HCV infection.

A brief rational: Pregnant women with HCV infection are at risk of adverse obstetric outcome. Anti-D Ig therapy may be a risk factor for HCV infection. Hence, we conducted a cross sectional study with the objectives to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. We found that anti-HCV and HCV-RNA seroprevalence were significantly higher in women with anti-D Ig. In addition, women with anti-D Ig therapy were 3.6 times more at risk of positive HCV-RNA with genotype HCV-1b showed higher prevalence. Therefore, anti-D Ig therapy is a risk factor for acquiring HCV infection and we recommend screening for HCV for all recipients of anti-D Ig. In addition, the diagnosis of HCV infection, should be made with HCV antibodies and HCV-RNA detection.     

Hepatitis C virus load during pregnancy and puerperium

Objective To assess whether pregnancy and delivery influence serum levels of hepatitis C virus (HCV) in carrier mothers.
Design A prospective study.
Setting University department of obstetrics and gynaecology.
Participants Ten pregnant HCV carriers (group A) and 8 nonpregnant HCV carriers (group B).
Methods Serum samples were collected for group A at first and third trimesters, delivery, postpartum 1,3,6,9 and 12 months, and at every three months for 1 year for group B.
Main outcome measures Each serum sample was tested for serum alanine aminotransferase (ALT), anti-HCV titre and HCV-cDNA concentration by a competitive polymerase chain reaction (PCR) with a sensitivity of 250 copies/mL serum.
Results In group A, the HCV levels remained unremarkably changed during pregnancy and delivery. However, all women had decreased HCV levels 1 and 3 months after delivery. Two women had undetectable serum HCV level postpartum and thereafter. Serum ALT values in 3 women were sporadically elevated, but did not correlate with decreased serum HCV levels. Anti-HCV titres remained unchanged during the study period. In two women from group B, the serum HCV levels were undetectable during follow up. Other 6 women showed fluctuations in the serum HCV levels but all were above 250 copies/mL. Serum ALT values were normal and anti-HCV titres remained stationary in all 8 nonpregnant carriers.
Conclusion Serum HCV levels are decreased 1 and 3 months after delivery. This fact might suggest that puerperium is an optimal time for antiviral therapy in HCV carrier mothers.     

Vertical transmission of hepatitis C virus and follow-up of newborns from infected mothers

BACKGROUND: Aim of the study is to analyze the rate of vertical transmission of HCV and the time of clearance of maternal antibodies in non-infected babies serum. METHODS: We have studied 36 babies born to HCV-positive and HIV-negative pregnant women at the University of Pavia. All mothers underwent blood tests to evaluate the presence of anti-HCV antibodies and viral RNA during pregnancy and after delivery. All babies underwent several tests at different times to evaluate the presence of viral RNA and the clearance of maternal antibodies. RESULTS: All babies proved HCV-Ab positive at birth, but only one case (2.7%) proved infected at PCR analysis. Different patterns of HCV-Ab clearance were noted in the 35 non-infected babies. Of 24 babies from HCV-RNA-positive mothers, HCV-Ab reached zero in 24 months while in 11 babies from HCV-RNA-negative mothers, the antibodies disappeared at 12 months. A statistical difference was noted between the two groups of babies for the time of clearance of antibodies. CONCLUSIONS: The risk of vertical transmission in babies born to HCV-RNA negative mothers is very low, and the clearance of maternal antibodies is set within 12 months of follow-up. Mothers positive to HCV-RNA have a higher risk of transmitting the virus to their offspring and the time of clearance of antibodies in non-infected babies seems to be longer. A correct follow-up of these children must be no shorter than 24 months.     

Maternal-fetal transmission of HCV. Role of HIV as a risk factor]

BACKGROUND: The aim of this study is to determine the rate of vertical transmission of hepatitis C and to analyse the concomitant infection by HIV as a risk factor. METHODS: We have studied the perinatal transmission of HCV in 22 pregnancies: 14 in women HCV+/HIV-, 8 in women HCV+/HIV+. We have performed the following tests on sera: test RIBA II to search for Ab anti-HCV, alanine transaminase (ALT) evaluation and HCV-RNA research by PCR. These tests were performed on sera from infants at birth and, then, during one year every three months. RESULTS: Within one year Ab anti-HCV disappeared in 20 of 22 pregnancies: two infants positive by Ab anti-HCV were born to HIV+ mothers and they were the only two who showed abnormal ALT values and detectable levels of HCV-RNA. Finally 10 of 14 infants born to HCV+/HIV- mothers were breast-fed and none was infected. CONCLUSIONS: We conclude that HCV mother-to-child transmission is an uncommon event, breast-milking is safety, and the concomitant infection by HIV could represent a risk factor for vertical transmission of hepatitis C.     

Seroprevalence and clinico-epidemiological correlates of hepatitis C viral antibodies at an antenatal booking clinic of a tertiary hospital in Nigeria

Purpose

This was to determine the sero-prevalence of hepatitis C viral (HCV) antibodies in pregnant women attending the first antenatal clinic and assess the epidemiologic correlates of women anti-HCV positive.

Methods

This was a prospective observational study which used in vitro diagnostic test kits to detect anti-HCV antibodies. Women attending their first antenatal clinic were recruited at the antenatal clinic of Irrua Specialist Teaching Hospital, Edo State, Nigeria. Seropositive women had liver enzymes assessed, and screening for hepatitis B surface antigen and Human Immuno-deficiency Virus (HIV) was done.

Results

Eight out of 205 women were anti-HCV positive. The prevalence of hepatitis C infection was 3.9 %. The mean age of the women was 28.9 ± 2.1 years. Most (50 %) anti-HCV positive women had tertiary level education. Though health workers made up 3.5 % of the participants, they constituted 25 % women with anti-HCV antibody. Awareness of HCV infection had no impact on the rate of infection. Multiple sexual partners (P = 0.71), blood transfusion (0.64) and female circumcision (P = 1.00) were not significant risks of infection. 2 (1 %) women had hepatitis B co-infection and 1 (12.5 %) woman had both HCV antibody and HIV co-infection.

Conclusion

Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.     

HCV and Pregnancy: Prevalence,Risk Factors,and Pregnancy Outcome in North Indian Population: A Case–Control Study

Objectives

The study was carried out to investigate the prevalence, risk factors, and Pregnancy outcome in anti-HCV-positives pregnant women admitted for delivery in the Department of Obstetrics & Gynecology of Guru Gobind Singh Medical College and Hospital, Faridkot between January 2010 and January 2013.

Setting

Department of obstetrics and Gynaecology of GGS Medical College and Hospital, Faridkot.

Material and Methods

A case–control study design was selected for the study. A total of 1412 pregnant women presenting in the labor room of our hospital between January 2010 and January 2013 were subjected to anti-HCV testing by third generation ELISA. Age, parity, and gestational age-matched controls were taken from the women delivering during the same time frame who tested negative for hepatitis C. All the subjects and controls were non-reactive for HIV and HBsAg as well. Risk factors and pregnancy outcome were compared with the control group. Approval was taken from ethic committee of the institute. The women who consented to participate in the study were evaluated on the basis of a questionnaire for the presence of risk factors of hepatitis C and pregnancy outcome. Women with the known previous liver disease were excluded from the study. Data were analyzed using SPSS for Windows version 16.0. p < 0.05 was considered significant.

Results

Forty patients tested positive for anti-HCV antibodies among 1,412 patients subjected to anti-HCV testing during study period. 40 patients were taken as controls, who were negative for anti-HCV antibodies. Prevalence of HCV during pregnancy was 2.8 % in our study. Among the risk factors studied, previous surgery and blood transfusion were the statistically significant risk factors. There was history of previous major surgery in 16 cases versus 4 controls and was statistically significant (p value 0.002) at p < 0.05. History of blood transfusion was present in 4 versus 2 among cases and controls, respectively, and statistically significant (p value 0.004) at p < 0.05. Sexual transmission was not the risk factor as none of the spouse of the pregnant women was positive for HCV antibodies. Neonatal outcome was similar in both groups. Pregnancy complications i.e., Pregnancy-induced hypertension and antepartum hemorrhage were significantly higher in study group compared to control group.

Conclusion

Incidence of hepatitis C virus infection in pregnancy is 2.8 %. Surgical procedures, blood transfusion, are the major risk factors for transmission. There are no identifiable risk factors in 35 % of cases. Pregnancy complications like Pregnancy-induced hypertension and antepartum hemorrhage are more common in HCV-positive mothers. Neonatal outcome is not affected. Universal screening of all pregnant women should be done for HCV as many patients may not have any risk factor.     

Prospective study of mother-to-infant transmission of hepatitis C virus: a 10-year survey (1990-2000)

BACKGROUND: The purpose of this study was to determine the rate of vertical transmission of hepatitis C virus (HCV). We also aimed to analyze the time of clearance of maternal antibodies in the serum of non-infected babies. METHODS: Between March 1990 and March 2000, 170 consecutive anti-HCV-positive women and their 188 babies entered this prospective study. All women were analyzed for HCV-RNA using polymerase chain reaction (PCR). The babies were followed-up until HCV-antibody clearance or until the diagnosis of HCV infection. RESULTS: The vertical transmission rate was 2.7% overall, and it was higher in HIV co-infected women (5.4%, 2/37) than in HIV-negative women (2.0%, 3/151). All infected infants were born to mothers who had HCV viremia at delivery. The transmission rate was influenced by maternal levels of viremia. 37.2% of uninfected children became HCV-antibody negative by 6 months and 88.0% by 12 months. Babies born from HCV-RNA-positive mothers lost anti-HCV antibodies later (9.21 +/- 3.72 months) than babies born from HCV-RNA-negative mothers (7.47 +/- 3.46 months) ( p < 0.05, Kolmogorov-Smirnov test). CONCLUSIONS: The risk of HCV vertical transmission is very low in HCV-positive/HIV-negative women and it is restricted to infants born to HCV viremic mothers. High maternal viral load is predictive of the vertical transmission. The clearance time of antibodies in non-infected babies is significantly longer if the mother is viremic.     

丙型庚型肝炎病毒母婴传播研究

目的 研究丙型、庚型肝炎病毒(HCV、HGV)母婴传播及其影响因素。方法 2000年1月至2002年12月应用第三代ELISA法检测HCV—Ab、HGV—Ab，FQ—PCR方法检测HCV—RNA、HGV—RNA。结果 2052例普通孕妇检测抗HCV阳性22例，阳性率1．07％，其中16例HCVRNA阳性母亲所生16例婴儿有3例HCVRNA阳性，母婴传播率为18．75％。318例普通孕妇检测抗HGV阳性8例，阳性率2．52％，其中4例HGVRNA阳性母亲所生4例婴儿1例HGVRNA阳性。结论 阴道分娩过程感染可能是HCV、HGV母婴传播主要途径，孕妇临产时创旧升高是孕妇母婴传播的危险因素。     

丙肝患者血清HCV RNA定量与抗-HCV检测结果分析

目的:探讨抗-HCV与HCV-RNA的相关性及临床应用价值。方法:ELISA方法检测抗-HCV,实时荧光定量PCR检测HCV-RNA。结果:检测可疑HCV感染者156例,其中119例抗-HCV阳性,同时HCV-RNA阳性为73例。HCV-RNA阳性患者中抗-HCV的阳性率显著高于抗-HCV阳性患者中HCV-RNA的阳性率(P<0.05)。结论:同时检测抗-HCV和HCV-RNA可提高HCV感染诊断的阳性率,检测HCV-RNA对抗病毒治疗的疗效评价及治疗时间有重要意义。     

Clinical characteristics of HCV infection in pregnancy: the role of sexual transmission]

BACKGROUND: There is no uniformity of opinions about the possibility of sexual transmission of hepatitis-C-virus infection. Moreover the infection during pregnancy is often underestimated. METHODS: One hundred and seventy-eight anti-HCV-positive pregnant women were investigated to evaluate the incidence of HCV infection and the possibility of sexual transmission of the disease to the partners. RESULTS: 126 patients out of 178 (70.8%) were positive for viral infection at PCR. In 96 patients (53.9%) HCV-positivity was detected for the first time in the actual pregnancy. 147 male partners out of 178 were checked for HCV-positivity and in 31 of them (21.1%) HCV antibodies were found. CONCLUSIONS: The results underline the importance of a screening for HCV-positivity in every pregnant, searching for anti-HCV antibodies also in patients not reporting risk factors. ALT values seem to be of little importance in the monitoring of the pathology. Sexual transmission of HCV virus from woman to man seems to occur rarely.     

Intra-hepatic cholestasis of pregnancy in hepatitis C virus infection

BACKGROUND: Aims of this study were to investigate whether hepatitis C virus infection influences the incidence and natural history of intrahepatic cholestasis of pregnancy (ICP) and whether ICP has different characteristics in hepatitis C virus (HCV) positive women from ICP in HCV negative women. METHODS: A prospective study for the prevalence of the HCV infection and for the incidence of ICP was carried out in the 5840 patients admitted to the Prenatal Department of Padua University, Italy, between January 1996 and January 1999. Testing was done for HCV by the enzyme linked immunosorbent assay (ELISA 3), recombinant immuno blot assay (RIBA 3) and polymerase chain reaction (PCR). The diagnosis of ICP was made on clinical grounds based on the occurence of pruritus with onset during pregnancy, persisting up to the time of delivery and disappearing after delivery, supported by demonstrating an elevation of both serum ALT and total serum bile acids. The Student's t-test, one way anova and chi-square tests were used for statistical analysis. RESULTS: During the study period, 56 of 5840 patients developed ICP (0.96%). Of these, 12 were also HCV-RNA positive. The rate of ICP was observed more commonly in HCV-RNA positive women than in HCV-RNA negative women (20.33% or 12/59 versus 0.78% or 44/5767, P = 0.001 CONCLUSIONS: Occurrence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Although the diagnosis of ICP is not confirmed by specific tests, we confirmed a higher risk of HCV infection in this condition. Therefore, occurence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Broader studies are necessary to assess the impact of infection on the perinatal outcome of ICP.     

Prevalence and risk factors for hepatitis C virus (HCV) infection among pregnant Brazilian women

Objectives: To determine the prevalence and the risk factors associated with HCV infection among women at childbirth, and to assess potential for infectivity of anti-HCV-positive women. Methods: A total of 6995 women were interviewed and screened for HCV antibodies. Association and logistic regression analyses were conducted. Results: The anti-HCV prevalence was 1.5% by EIA-3 and 0.8% by RIBA-3; HCV-RNA (RT-PCR) was detected in 74% of the RIBA-positive samples. Blood transfusion, race (blacks), alcohol abuse, a history of STD and anti-HBc positivity were independent risk factors for HCV positivity. Except for parenteral exposure, independent predictors of anti-HCV were a history of STD, anti-HBc positivity, a sex partner with multiple sex partners and a sex partner with a history of hepatitis. Conclusions: The prevalence of anti-HCV is higher in pregnant women than in blood donors. Sexual exposure may facilitate the spread of HCV and there is a high potential for mother-to-infant transmission.     

Prevalence of antibody to hepatitis C virus in pregnant Taiwanese.

To assess the prevalence of an antibody to hepatitis C virus (anti-HCV) in pregnant women in Taiwan, and elucidate whether or not there is superinfection of the hepatitis B virus (HBV) in such cases, we investigated two independent groups of pregnant women. Group A included 294 without serum alanine aminotranferase (ALT) screening, and group B included 171 pregnant women with an abnormal ALT level (greater than 45 IU/L) who were recruited from 9,523 pregnant women screened for ALT. Blood samplings were taken at early gestation and each serum sample was tested with an HCV EIA kit for anti-HCV. The results showed that 1 woman in group A (0.34%) and 4 women in group B (2.3%) were anti-HCV-positive. However, all 5 cases showed positive antibodies to both the hepatitis B surface and core antigens, but were negative for the hepatitis B surface antigen. Therefore, the prevalence of anti-HCV in pregnant women by current assay in Taiwan is 0.34% without ALT screening, but increases to 2.3% among abnormal ALT cases. The prevalence rate is less than the rates reported in other countries. If confirmed by subsequent study, the results suggest that infection with HCV is low among healthy young females in Taiwan today.     

Prevalence of hepatitis B and C in the maternity department of a Greek district hospital.

OBJECTIVE: To define the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HBC), and the modifications observed during the last 8 years, amongst parturients who gave birth in our department. DESIGN: This was a retrospective study. PATIENTS: The 5497 parturients who gave birth in our department between October 1994 and September 2002. RESULTS: On average, 3.87% (213) of the pregnant women tested positive for hepatitis B surface antigen; 2.90% amongst pregnant Greek women and 4.67% amongst pregnant immigrant women. Among all pregnant women, 0.80% (44) tested positive for antibodies against HCV; 0.16% amongst Greek women and 1.33% amongst immigrant women. CONCLUSIONS: HBV prevalence in pregnant women did not seem to be affected by the increase of immigrants in our obstetric population over the course of time. HCV prevalence in the pregnant women, however, did seem to follow the increase of immigrants in our obstetric population. Economic and security issues unfortunately deprive some neonates, born to mothers with HBV infection, from the use of hepatitis B immunoglobulin.     

Mother-to-child transmission of hepatitis C virus: recent news about the benefit of caesarean sections

The rate of mother-to-infant transmission for hepatitis C virus is estimated to be around 5% of viraemic mothers and represents an important route of HCV infection among children. Transmission is possible in utero but the highest risk of infection is at or near the time of delivery because of an important blood transmission of hepatitis C virus. Mothers with high levels of HCV-RNA and co-infected for human immunodeficiency virus are documented to have risk factors for vertical transmission of HCV. Thus, for these, the mode of delivery must be discussed even if there are no precise recommendations. Among obstetrical risk factors, the results of literature fail to prove a benefit of elective caesarean delivery in the aim to reduce the vertical transmission of HCV. However, obstetrical situations with a high risk of blood contact between mother and foetus must be considered and if possible evicted.     

Hepatitis C and pregnancy

Hepatitis C is the most common chronic bloodborne infection in the United States. The diagnosis of vertical transmission is reliably established by a positive serum hepatitis C virus (HCV) RNA on 2 occasions 3 to 4 months apart after the infant is at least 2 months old and/or by the detection of anti-HCV antibodies after the infant is 18 months old. Vertical transmission in HCV RNA-negative pregnant women is approximately 1% to 3% versus approximately 4% to 6% in HCV RNA-positive women. From the standpoint of vertical transmission, no critical HCV RNA titer has been established. Coinfection with HIV has been shown to increase the risk of vertical transmission of HCV, but highly active antiretroviral therapy may decrease the risk significantly. In HIV-negative women, route of delivery does not influence vertical transmission. In HCV/HIV-coinfected women, decisions regarding mode of delivery should be based on HIV status. There is no association between vertical transmission of HCV and gestational age at delivery or the presence of chorioamnionitis. The use of a scalp electrode has been associated with vertical transmission and this practice is discouraged. Data are conflicting regarding duration of ruptured membranes and the risk of vertical transmission of hepatitis C. When the duration of membrane rupture exceeds 6 hours, the risk may be increased. There is no evidence demonstrating an increased risk of HCV transmission in HIV-negative women who breast feed. In HCV/HIV-coinfected women, breast feeding is discouraged in women who have consistent access to safe infant formula. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that vertical transmission of hepatitis C (HCV) does occur, state that coinfection with HIV increases the transmission rate, and summarize that there is no association between gestational age or presence of chorioamnionitis and no evidence that a cesarean delivery prevents transmission.     

Hepatitis B and C in pregnancy

In general, pregnancy does not influence the course of hepatitis B (HBV) and C (HCV) infection. Most neonates born to mothers who suffer from acute viral hepatitis B and C are asymptomatic. Chronic hepatitis B and C infections can be transmitted to neonates. This route of transmission of HBV is a major contributing factor to the high carrier rate in endemic countries where 80–95% of infants born to HBsAg/HBeAg-positive (hepatitis B surface antigen and hepatitis B e antigen respectively) mothers are infected. Despite the availability of a immunoprophylactic vaccine, 10–15% of these infants are still infected. The possible reasons for vaccine failure include the ability of HBV antigens to induce immunotolerance and the existence of HBV variants. The factors contributing to vertical transmission of HBV and HCV are also discussed. These factors include viral load, virus variants and sensitivity of diagnostic tests. The rate of vertical transmission of HCV of less than 5% is lower compared to HBV in HCV-ribonucleic-acid-positive mothers. However, the risk of HCV transmission is increased to about 23% if the pregnant women are also human immunodeficiency virus (HIV) positive.     

Hepatitis C in pregnancy

Hepatitis C is the most common cause of chronic liver disease and liver transplantation, with 25,000 cases reported in the United States per year. By blood product screening, transfusion-related viral transmission has been virtually eliminated, and maternal fetal transmission is now one of the most important modes of transmission. Hepatitis C virus (HCV) infection is blood borne but only 25% of the infected pregnant women indicate a history of blood products transfusion or intravenous drug use. HCV transmission is 2- to 4-fold higher in women coinfected with HIV. Although cesarean delivery has not been shown to decrease perinatal transmission, it may have benefits in women with viremia at the time of delivery. During pregnancy, treatment of HCV is contraindicated, even though perinatal transmission is associated with a higher incidence of chronic liver disease. This review gives an update on the disease agent, risk factors, modes of transmission, diagnosis, treatment modalities, and perinatal issues that require further evaluation.     

妊娠期肝炎病毒多重感染对母婴的影响

目的 探讨妊娠期肝炎病毒多重感染对母婴的影响。方法 对1994年1月至1999年12月在我院产前检查,肝功能异常的孕妇行甲、乙、丙、丁、戊等5种肝炎病毒标记物检测,其中确诊为肝炎病毒多重感染者32例（多重感染组）,确诊为肝炎病毒单一感染者32例（单一感染组）,对两组母儿并发症及预后进行观察比较。结果 两组丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清总胆红素（TBIL）水平比较,差异无显著性（P＞0．05）。多重感染组乙型肝炎病毒e抗原（HBeAg)阳性率（35．7％）显著低于单一感染组（76．9％,P＜0．05）,而乙型肝炎病毒e抗体（HBeAb)阳性率（57．1％）显著高于单一感染组（15．4％,P＜0．01）。多重感染组孕妇妊娠高血压综合征（妊高征）、产后出血、重症肝炎、死亡的发生率与单一感染组比较,差异无显著性（P＞0．05）。而多重感染组胎膜早破、早产的发生率（28．1％,25．0％）明显高于单一感染组（6．3％、3．1％,P＜0．05）;胎儿宫内窘迫及新生儿窒息的发生率（31．3％,25．0％）显著高于单一感染组（9．4％、0．0％,P＜0．05、P＜0．01）。结论 妊娠期肝炎病毒多重感染对孕妇的影响无明显加重,而对围产儿的影响较为明显;应加强孕期保健,防止胎膜早破及早产的发生。