Hepatitis C and pregnancy are a combination that frightens expectant mothers. Unfortunately, these days this diagnosis is increasingly being discovered during pregnancy. The disease is diagnosed using standard screening for infections - HIV, hepatitis B and C, which all expectant mothers undergo. According to statistics, the pathology is found in every thirtieth resident of our country, that is, the disease is quite common.

Today, very little is known about the interaction between chronic hepatitis C and pregnancy. It is only known that the consequences of this condition may include miscarriage and premature birth, the birth of a child with insufficient body weight, infection of the fetus during childbirth, and the development of gestational diabetes in the expectant mother.

Hepatitis C is a viral liver disease. The virus enters the human body mainly through the parenteral route - through the blood. Signs of hepatitis C infection usually appear in an erased form, so the pathology, remaining undetected at a certain moment, easily becomes a chronic process. The prevalence of hepatitis C among the population is steadily increasing.

Main routes of infection:

blood transfusion (fortunately, in recent years this factor has lost its significance, since all donor plasma and blood are necessarily tested for the presence of the virus);
unprotected sexual intercourse with a virus carrier;
using a syringe after a sick person;
non-compliance with personal hygiene standards - sharing razors, nail scissors, toothbrushes with a virus carrier;
infection with contaminated instruments when applying piercings and tattoos to the skin;
professional activities related to blood - infection occurs accidentally, for example, during hemodialysis;
infection of the fetus during its passage through the birth canal.

The virus is not transmitted through household contact and airborne droplets.

Risk groups for hepatitis C infection include:

people who underwent surgery before 1992 inclusive;
health care workers who regularly work with people infected with hepatitis C;
people who use drugs by injection;
HIV-infected persons;
people suffering from liver pathologies of unknown origin;
persons regularly receiving hemodialysis;
children born to infected women;
people who are promiscuous without using condoms.

Symptoms

It should be noted that most people infected with the hepatitis C virus do not notice any symptoms for a long time. Despite the fact that the disease is hidden, a mechanism of irreversible processes is triggered in the body, which can ultimately lead to the destruction of liver tissue - cirrhosis and cancer. This is the insidiousness of this disease.

In approximately 20% of infected people, symptoms of the pathology still appear. They complain of general weakness, drowsiness, deterioration in performance, lack of appetite and constant nausea. Most people with this diagnosis lose weight. But most often there is discomfort in the right hypochondrium - exactly where the liver is located. In rare cases, pathology can be judged by pain in the joints and rashes on the skin.

Diagnostics

In order to make a diagnosis, a probable carrier of the virus must undergo the following diagnostic tests:

determination of antibodies to the virus in the blood;
determination of AST and ALT, bilirubin in the blood;
PCR - analysis to determine the RNA of the virus;
ultrasound examination of the liver;
liver tissue biopsy.

If the studies have shown a positive result for the presence of hepatitis C in the body, this may indicate the following facts:

A person is sick with a chronic form of the disease. He should undergo a biopsy of liver tissue in the near future to clarify the extent of its damage. You also need to do a test to identify the genotype of the virus strain. This is necessary to prescribe appropriate treatment.
The person has had an infection in the past. This means that the virus previously entered the person’s body, but his immune system was able to cope with the infection on its own. There is no data on why the body of specific people was able to overcome the hepatitis C virus, while others continue to suffer from it. It is generally accepted that much depends on the state of immune defense and the type of virus.
The result is false positive. Sometimes it happens that during the initial diagnosis the result may be erroneous, but upon repeated analysis this fact is not confirmed. The analysis needs to be repeated.

Features of the course of infection in pregnant women

Typically, the course of hepatitis C has no relationship with the process of pregnancy; complications occur quite rarely. A woman suffering from this disease requires more careful monitoring throughout her gestation period, since she has an increased risk of spontaneous abortion and the likelihood of developing fetal hypoxia compared to healthy women.

A patient with this disease should be monitored not only by a gynecologist, but also by an infectious disease specialist. The probability of fetal infection during pregnancy and childbirth is no more than 5%. However, it is impossible to prevent the baby from becoming infected 100%. Even if a woman, as a carrier of hepatitis C, undergoes an operative birth - a cesarean section, this is not a prevention of infection.

Therefore, after birth, the child is tested to determine the virus in the blood. In the first 18 months of a baby's life, antibodies to hepatitis C obtained during pregnancy can be detected in the blood, but this cannot be a sign of infection.

If the baby’s diagnosis is still confirmed, it is necessary to monitor him more carefully with a pediatrician and infectious disease specialist. Children born to infected mothers are allowed in any case, since the virus is not transmitted through milk.

Treatment methods for pregnant women

Currently, there is no vaccine against the hepatitis C virus. But it can be treated. The main thing is to notice the infection in time: the chances of recovery will be higher if the infection was noticed at the very beginning.

Treatment of hepatitis C must be comprehensive. The basis of therapy is drugs that have a powerful antiviral effect. Ribavirin and Interferon are most often used for this purpose. But, according to additional studies, these drugs have a negative effect on the developing fetus. Therefore, it is not advisable to treat hepatitis C during pregnancy.

There are cases when specialists are forced to prescribe specific therapy to a woman. This usually happens when the expectant mother develops clear symptoms of cholestasis. In this situation, her condition deteriorates sharply, and something urgently needs to be done. This happens infrequently - in one woman out of 20.

If there is a need to treat hepatitis C during pregnancy, doctors give preference to those medications that are relatively safe for the expectant mother and her child. Usually this is a course of injections based on ursodeoxycholic acid.

How is childbirth carried out in infected women?

In obstetrics, statistics have long been kept on which method of delivery increases the risk of infection of the newborn or, on the contrary, decreases. But unambiguous statistics have not yet been obtained, since the probability of infection during childbirth is approximately the same both in the case of a cesarean section and in the natural process.

If a woman has hepatitis C, delivery will be carried out by caesarean section if liver tests are unsatisfactory. Usually this happens to one expectant mother out of 15. In other cases, doctors choose the method of delivery based on the patient’s health condition.

Infection of a child during childbirth can only occur from the mother’s blood at the moment when the baby passes through the birth canal. If medical personnel are aware of the mother's illness, then infection of the child is almost impossible - no more than 4% of cases. The experience and professionalism of doctors will help to eliminate as much as possible the baby’s contact with the mother’s blood secretions; in some cases, an emergency caesarean section is performed.

Prevention of hepatitis C

When planning a pregnancy, every woman should be tested for the presence of hepatitis C virus in her blood. Since infection usually occurs through contact with the blood secretions of a sick person, you should try to avoid any interactions with this physiological environment.

You cannot share needles, water, tourniquets and cotton wool, that is, all items that are used for injections. All medical instruments and dressings must be disposable or sterilized. You should also not use someone else’s toothbrushes, manicure items, or earrings, since the virus can remain viable on all these things for up to 4 days.

Hepatitis C is a viral anthroponotic infection with predominant liver damage, prone to long-term chronic asymptomatic course, and outcome in liver cirrhosis and primary hepatocellular carcinoma. Hepatitis with a blood-contact mechanism of pathogen transmission.

SYNONYMS

Hepatitis C; viral hepatitis non-A, non-B with parenteral transmission mechanism.
ICD-10 CODE
B17.1 Acute hepatitis C.
B18.2 Chronic viral hepatitis C.

EPIDEMIOLOGY

The source and reservoir of hepatitis C is a patient with acute or chronic infection. HCV RNA can be detected in the blood very early, already 1–2 weeks after infection. From an epidemiological perspective, the most unfavorable are the inapparent (subclinical) forms of hepatitis C, which predominate in this disease. The prevalence of infection to a certain extent characterizes the infection of donors: in the world it ranges from 0.5 to 7%, in Russia it is 1.2–4.8%.

Hepatitis C, like hepatitis B, has a blood-borne route of infection; they have the same transmission factors and high-risk groups for infection. The infectious dose of HCV is several times higher than that of HBV: the probability of contracting hepatitis C when injected with a needle contaminated with the pathogen reaches 3–10%. Contact of infected blood with intact mucous membranes and skin does not lead to infection. Vertical transmission of HCV is a rare phenomenon, and some authors deny it. The likelihood of domestic and professional infection is low, but the incidence of hepatitis C in medical workers is still higher (1.5–2%) than in the general population (0.3–0.4%).

The leading role in risk groups belongs to drug users (drug addicts' hepatitis). The role of sexual and intrafamily contacts in hepatitis C infection is insignificant (about 3%). For comparison: the risk of sexual transmission of HBV is 30%, HIV is 10–15%. In the case of sexually transmitted infection, transmission of the pathogen most often occurs from man to woman.

Hepatitis C is found everywhere. It is believed that at least 500 million people in the world are infected with HCV, i.e. There are significantly more HCV infected people than HBSAg carriers.

7 genotypes and more than 100 subgenotypes of the hepatitis C virus have been identified. In Russia, one genotype dominates, and three genotypes occur.

The increase in incidence in the world and in the country is partly of a registration nature (improved diagnosis throughout the country with the beginning of mandatory registration of hepatitis C in 1994), but there is also a true increase in the number of patients.

CLASSIFICATION

There are acute and chronic forms (phase) of hepatitis C. The latter is usually divided into subclinical and manifest (reactivation phase).

ETIOLOGY (CAUSES) OF HEPATITIS C

The causative agent of hepatitis C (HCV) is an RNA virus. It is characterized by extreme variability, which hinders the creation of a vaccine. The virus contains structural proteins: core (heart-shaped), E1 and E2 and non-structural proteins (NS2, NS3, NS4A, NS4B, NS5A and NS5B), the detection of which is used to verify the diagnosis of hepatitis C, incl. its forms (phases).

PATHOGENESIS

Having entered the human body through the entrance gate, the pathogen penetrates hepatocytes, where it replicates. The direct cytopathic effect of HCV has been proven, but the hepatitis C virus has weak immunogenicity, so elimination of the pathogen does not occur (just like HAV, which has a direct cytopathic effect). Antibody formation in hepatitis C is imperfect, which also prevents the neutralization of the virus. Spontaneous recovery is rare. 80% or more of those infected with HCV develop chronic hepatitis with long-term persistence of the pathogen in the body, the mechanism of which is different from the persistence of HBV. With hepatitis C, there are no integrative forms due to the special structure of the virus (it has neither template nor intermediate DNA). The persistence of the pathogen in hepatitis C is explained by the fact that the rate of mutation of viruses significantly exceeds the rate of their replication. The resulting antibodies are highly specific and cannot neutralize rapidly mutating viruses (“immune escape”). Long-term persistence is also facilitated by the proven ability of HCV to replicate outside the liver: in the cells of the bone marrow, spleen, lymph nodes, and peripheral blood.

Hepatitis C is characterized by the inclusion of autoimmune mechanisms, resulting in numerous extrahepatic manifestations of chronic hepatitis C.

What distinguishes hepatitis C from other viral hepatitis is its torpid subclinical or asymptomatic course and, at the same time, its asymptomatic but steady progression of the pathological process in the liver and other organs, especially in older people (50 years or more) suffering from concomitant pathology, alcoholism, drug addiction, protein-energy insufficiency, etc.

Most researchers believe that the genotype of the virus does not affect the progression of the disease and its rate. An immunogenetic predisposition to hepatitis C is possible.

Chronic hepatitis C usually occurs with minimal or weak activity of the pathological process and unexpressed or moderate fibrosis (according to the results of intravital liver biopsies), but often the rate of fibrosis is quite high.

PATHOGENESIS OF GESTATION COMPLICATIONS

The pathogenesis, as well as the range of complications of gestation, is the same as with other hepatitis, but they are very rare.

CLINICAL PICTURE (SYMPTOMS) OF HEPATITIS C IN PREGNANT WOMEN

In most patients, acute hepatitis C occurs subclinically and, as a rule, is not recognized. When examining the focus of infection in patients without clinical manifestations, a moderate increase in the activity of ALT, antibodies to the causative agent of hepatitis C (anti-HCV) and/or RNA virus in PCR is determined. Manifest forms are usually mild, without jaundice. The duration of the incubation period is therefore very difficult to determine.

The prodromal period is similar to that of hepatitis A and B; its duration is difficult to estimate. During the peak period, some patients develop mild, rapidly passing jaundice; heaviness in the epigastric region and right hypochondrium is possible. The liver is slightly or moderately enlarged.

Seroconversion (appearance of anti-HCV) occurs 6–8 weeks after infection. HCV RNA can be detected from the blood of an infected person within 1–2 weeks.

Chronic hepatitis C is almost always subclinical or asymptomatic, but viremia persists, often with a small viral load, but high replicative activity of the pathogen is also possible. In these cases, the viral load can be high. As the disease progresses, a periodic wave-like increase in ALT activity (3–5 times higher than normal) is noted when patients feel well. In this case, anti-HCV is determined in the blood. It is also possible to isolate HCV RNA, but not consistently and in low concentrations.

The duration of chronic hepatitis C can vary, most often it is 15–20 years, but often longer. In some cases, the duration of the disease is noticeably reduced with superinfection, and most of all with mixed HCV+HIV infection.

The reactivation phase of hepatitis C is manifested by the manifestation of symptoms of a chronic disease with subsequent outcome in liver cirrhosis and primary hepatocellular cancer against the background of progressive liver failure, hepatomegaly, often with splenomegaly. At the same time, biochemical signs of liver damage worsen (increased ALT, GGT, dysproteinemia, etc.).

Chronic hepatitis C is characterized by extrahepatic symptoms (vasculitis, glomerulonephritis, cryoglobulinemia, thyroiditis, neuromuscular disorders, articular syndrome, aplastic anemia and other autoimmune disorders). Sometimes it is precisely these symptoms that become the first sign of chronic hepatitis C, and patients are first diagnosed correctly. Thus, with autoimmune symptoms, mandatory examination of patients for hepatitis C using molecular biological and immunoserological methods is necessary.

The outcomes of chronic hepatitis C are cirrhosis and liver cancer with corresponding symptoms. It is important that the risk of liver cancer with hepatitis C is 3 times higher than with hepatitis B. It develops in 30–40% of patients with cirrhosis.

Primary hepatoma in hepatitis C progresses quickly (cachexia, liver failure, and gastrointestinal manifestations are noted).

Complications of gestation

In most cases, hepatitis C occurs as in non-pregnant women. Complications are very rare. Management of a pregnant woman with hepatitis C includes careful observation to timely determine the possible threat of miscarriage and fetal hypoxia. Some pregnant women occasionally experience clinical and biochemical signs of cholestasis (skin itching, increased activity of alkaline phosphatase, GGT, etc.); the development of gestosis is possible, the frequency of which usually increases with extragenital diseases.

DIAGNOSIS OF HEPATITIS C IN PREGNANCY

Recognizing hepatitis C is a clinically difficult task due to the peculiarities of the course and mild or absent symptoms for a long time.

Anamnesis

A well-conducted epidemiological history is important, during which it is possible to determine the patient’s predisposition to a group at high risk of contracting hepatitis C (as with hepatitis B). When collecting anamnesis, you should pay special attention to episodes of unclear ailments in the past and signs characteristic of the prodromal period of viral hepatitis. A history of jaundice, even mild, obliges the patient, including a pregnant woman, to be examined for hepatitis, including hepatitis C.

Laboratory research

Of primary importance is the diagnosis of hepatitis using biochemical methods, as with other etiological forms of viral hepatitis. The results of detection of hepatitis C markers are of decisive and verifying importance. Anti-HCV is determined in the blood using the ELISA method, and a reference test is performed. The detection of HCV RNA in the blood or liver tissue using the PCR method has the greatest diagnostic value, since it indicates not only the etiological diagnosis, but also the ongoing replication of the virus. The presence of anti-HCV is important for the verification of hepatitis C; simultaneous determination of antibodies to non-structural proteins (especially anti-HCV NS4) indicates chronic hepatitis C. A high viral load when quantifying HCV RNA may correlate with high activity of the pathological process and accelerated rates of cirrhosis formation liver; in addition, this indicator is used to judge the effectiveness of antiviral therapy.

In chronic hepatitis C, an important place in the diagnosis and determination of prognosis is occupied by intravital liver biopsy with assessment of the activity of the pathological process (minimal, low, moderate, severe) and the degree of development of fibrosis.

Pregnant women are required (as with hepatitis B) to be screened for hepatitis C.

Differential diagnosis

Differential diagnosis is carried out as for other viral hepatitis.

Indications for consultation with other specialists

Pregnant women with hepatitis C are monitored by an infectious disease specialist and an obstetrician-gynecologist. In case of autoimmune signs of chronic hepatitis C, the help of specialists in the relevant field may be required, for drug-addicted women - a narcologist, a psychologist.

An example of a diagnosis formulation

Pregnancy 17–18 weeks. Chronic hepatitis C, low degree of activity of the pathological process, weak fibrosis.

TREATMENT OF HEPATITIS C DURING PREGNANCY

For manifest forms of hepatitis C (acute and chronic), therapy is carried out as for hepatitis B, using methods of drug pathogenetic and symptomatic therapy.

Drug treatment

Outside of pregnancy, the basis of therapy is interferon alpha antiviral drugs (with a 6-month course for acute hepatitis and a 6-12-month course for chronic hepatitis).

If HCV RNA continues to circulate after 3 months from the start of interferon therapy (or if hepatitis C relapses after completing a course of interferon alfa), treatment of patients is supplemented with ribavirin.

During pregnancy, etiotropic antiviral therapy for hepatitis C is contraindicated; if necessary, pathogenetic and symptomatic treatment of patients is carried out.

Prevention and prediction of gestational complications

Prevention and prediction of gestational complications is carried out according to the general rules adopted in obstetrics.

Features of treatment of complications of gestation

There are no particularities in the treatment of complications of gestation, including in each trimester, during childbirth and the postpartum period.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

If autoimmune signs of hepatitis C develop, consultations with specialists of the necessary profile are indicated to coordinate treatment methods with them. If the course of the disease worsens, provide observation by an infectious disease specialist.

INDICATIONS FOR HOSPITALIZATION

In many cases of chronic hepatitis C, it is possible to manage pregnant women on an outpatient basis (with a favorable course of infection and gestation). In the acute phase of hepatitis C in pregnant women, hospitalization in an infectious diseases hospital and observation by an obstetrician-gynecologist are necessary.

ASSESSMENT OF TREATMENT EFFECTIVENESS

With the correct management tactics for pregnant women with hepatitis C, the effectiveness of treatment for possible rare complications is the same as for non-pregnant women.

CHOICE OF DATE AND METHOD OF DELIVERY

All efforts of obstetricians should be aimed at ensuring that patients with hepatitis C give birth on time through the natural birth canal.

INFORMATION FOR THE PATIENT

Vertical transmission of the hepatitis C pathogen to the fetus is possible, but extremely rare. HCV is not transmitted through mother's milk, therefore, there is no need to stop breastfeeding.

Women suffering from chronic hepatitis C who are planning a pregnancy should undergo a full cycle of vaccination against hepatitis B, in order to avoid subsequent mixed infection B + C. The same should be done after delivery (if there was no vaccination against hepatitis B before pregnancy).

The detection of anti-HCV in a newborn for 18 months is not considered a sign of infection (Abs are of maternal origin). Further monitoring of the child involves examining him at 3 and 6 months of life using PCR for the possible detection of HCV RNA, the presence of which (if detected at least 2 times) will indicate infection (if the genotype of the virus is the same in the mother and child).

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

A variety of liver dysfunction in a pregnant woman can be caused by pregnancy, or can only coincide with it in time. If pregnancy proceeds normally, the structure of the liver does not change, but during this period there may be a temporary disruption of its function. This disorder occurs as a reaction of the liver to a sharp increase in the load on it due to the need to neutralize fetal waste products. In addition, during pregnancy, starting from the first trimester, the content of hormones, primarily sex hormones, the exchange of which also occurs in the liver, increases significantly. Temporary dysfunction in pregnant women can lead to changes in some biochemical parameters. Similar changes also appear during liver diseases, therefore, to diagnose the stability of the disorder, they should be examined in dynamics, repeatedly, and compared with the physical state of the pregnant woman. If within 1 month after birth all the changed indicators returned to normal, the disorder was temporary, caused by pregnancy. If normalization is not observed, this may confirm hepatitis. The main cause of hepatitis is viruses.

Acute viral hepatitis

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

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 is cured spontaneously, without the intervention of doctors. Viral hepatitis A is an intestinal infection. 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. In the vast majority of cases, this type of viral hepatitis does not become chronic; there is no carriage of the virus. People who have undergone HCV A acquire lifelong immunity. Typically, hepatitis A does not have a significant effect on the course of pregnancy and childbirth, or on the development of the fetus. The child will be born healthy. He is not at risk of infection and does not need special prevention. If the disease occurs in the second half of pregnancy, it is usually accompanied by a deterioration in the woman’s general condition. Childbirth can worsen the course of the disease, so it is advisable to delay the delivery date until the end of jaundice.

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

Hepatitis E Like hepatitis A, it is spread through the fecal-oral route, with the source of infection usually being contaminated water. This virus is especially dangerous for pregnant women, since the incidence of severe forms of the disease is high when infected.

In general, the clinical course of hepatitis 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 without improvement for at least 6 months. Up to 70-80% of all chronic hepatitis are hepatitis of viral etiology (hepatitis B and C viruses). The remaining part accounts for autoimmune toxic (for example, drug) and nutritional (in particular, alcoholic) hepatitis. Pregnancy due to hCG 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 developing infertility. This is explained by the fact that the liver is an organ involved in the metabolism of hormones, and during 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 a normal menstrual cycle. However, in some cases, doctors manage to achieve remission of the disease, restoration of menstrual function and fertility. However, permission to continue pregnancy can only be given by a antenatal clinic physician or a hepatologist after a thorough comprehensive examination of the woman. Therefore, a pregnant woman suffering from hCG should be hospitalized in a hospital already in the first trimester, where there is an opportunity for a full examination. The degree of activity and stage of hCG outside pregnancy are determined by morphological examination of a liver biopsy. Liver biopsies are not performed in pregnant women in our country, so the main diagnostic methods are clinical (based on an analysis of the woman’s complaints and her life history) and laboratory.

Diagnostics

The main clinical signs of hepatitis in pregnant women, as well as in non-pregnant women, are the same 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, can understand the causes of these conditions. Do not self-medicate, because after all, hepatitis cannot be completely ruled out before examination, and you will waste precious time. If you suspect AVH, the doctor always tries to find out whether there was a possibility of infection, asking about contacts, recent travel, previous injections and operations, blood transfusions, dental treatment, presence of tattoos, piercings, eating unwashed vegetables, fruits, raw milk, shellfish (4 epidemics of AHSA have been described due to the consumption of raw shellfish and oysters from contaminated water bodies).

To resolve the issue of possible viral liver damage, to determine the type of virus and stage of the disease, it becomes necessary to conduct special tests. One of them is a blood test for the presence of HBs antigen (HBs – Ag 2 ). The HBs antigen is a fairly reliable sign of infection with the hepatitis B virus. Since hepatitis B is a widespread infectious disease, 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 is a need for mandatory testing for this virus.

During pregnancy, it is now mandatory to donate blood three times to detect the HBs antigen. In the absence of a negative test during the last three months before birth or with a positive test for HBs-Ag, a pregnant woman, as a rule, cannot give birth in the same maternity unit with uninfected women in labor. This frequency of testing is associated with the possibility of false negative results, as well as the likelihood of infection already during pregnancy as a result of injections, dental treatment, etc.

Since in diagnosing the activity (aggression) of chronic hepatitis during pregnancy, doctors cannot resort to 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 during breakdown of liver cells. The degree of their activity corresponds to the intensity of the inflammatory process in the liver and is one of the main indicators of the dynamics of hepatitis. Therefore, the doctor may recommend 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. Ultrasound examination of internal organs helps in diagnosing the stage of hepatitis.

Treatment

Drug therapy has undergone significant changes in recent years. For the treatment of viral hepatitis, practically the only group of drugs is etiotropic, 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 blood leukocytes in response to exposure to the virus. They can be called antiviral antibiotics. However, this type of therapy is not used during pregnancy, which is associated with potential danger to the fetus. Treatment with other groups of drugs is carried out strictly as prescribed by the doctor.

Pregnant women who have recovered from CVH or suffer from CVH in remission do not need drug therapy. They should be protected from exposure to hepatotoxic substances (alcohol, chemical agents - varnishes, paints, car 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, and hypothermia. You should adhere to a 5-6 meals a day diet, following a special diet (the so-called table No. 5). Food should be rich in vitamins and minerals.

A pregnant woman suffering from hCG should remember that a favorable course of the disease in some cases can turn into a severe one at any time, so she must strictly adhere to all the advice of the doctor supervising her.

Women with acute viral hepatitis give birth in special infectious diseases departments. Pregnant women suffering from hepatitis of non-viral etiology, who do not pose 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 normal delivery, then, as a rule, the woman gives birth herself, through the natural birth canal. In some cases, doctors resort to caesarean section.

Hormonal contraception for women suffering from hepatitis is contraindicated, since both their own hormones and hormones introduced externally with a contraceptive pill are metabolized in the liver, and its function is significantly impaired in hepatitis. 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 negatively affect the development of the fetus, since with severe impairment of liver function, fetoplacental insufficiency develops due to circulatory disorders and changes in the blood coagulation system. Currently, there is no clear answer to the question of the teratogenic effect of hepatitis viruses on the fetus. The possibility of vertical (from mother to fetus) transmission of the virus has been proven. Breastfeeding does not increase the risk of infection in the newborn; the risk increases if the nipples are damaged and there are erosions or other damage to the newborn's oral mucosa.

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

A very large percentage of women in such a developed country as Russia detect the hepatitis C virus in their blood when they begin to undergo routine examination in the early stages of pregnancy.

On the one hand, earlier is better than “late”, given the insidious nature of the development of the disease. On the other hand, it is an alarming indicator of the scale of the spread of the virus and our attitude towards our health.

What you need to know about hepatitis?

Hepatitis is a dangerous infectious inflammatory disease of the liver.

There are several types of hepatitis - A, B, C, D and E. The common unifying feature of these diseases is that they are all diseases of one organ - the liver. And the difference is manifested in the severity of the disease and its consequences, methods and time of treatment, and the possibility of cure as such.

In addition, the causative agent Each type of hepatitis is caused by different viruses. Therefore, the hepatitis B vaccine will be helpless in trying to neutralize the hepatitis C virus once it enters the human body.

It is important to know that there are different types of hepatitis and they are transmitted differently. So, the most common hepatitis A, or banal jaundice, can be infected through unwashed vegetables and fruits and by drinking unboiled water.

Hepatitis E You can get infected in a similar way. But there is an important difference - this type of disease is very widespread in the so-called “third world countries” with a hot tropical climate. The lack of sufficient clean drinking water and the low level of medical development contribute to the high prevalence of the disease.

Hepatitis E is extremely dangerous for pregnant women, fraught with severe pregnancy and dangerous complications for the woman and child.

Therefore, if you have already found yourself in these conditions, it is recommended to avoid drinking suspicious water and even ice, the safety of which may be in doubt.

Hepatitis B and hepatitis C virus enters the body through blood or sexual contact. If pregnant, an infected woman has a chance of inheriting hepatitis C through the placenta or during childbirth.

Certain types of hepatitis are relatively easy to diagnose and treat. For example, acute form of hepatitis B, which initially resembles the flu, already on the third day from the onset of the disease shows characteristic symptoms: nausea and vomiting, jaundiced skin and pain in the right hypochondrium.

With a correct and timely diagnosis and professional care, acute hepatitis B can be cured within a week or two, and hepatitis C can be cured within six months without fatal consequences.

If the acute stage of the disease transitions to chronic, treatment takes not months, but years, and there is no 100% chance of complete recovery. In the worst case, it can end in cirrhosis or liver cancer.

A common characteristic feature of all types of hepatitis is yellowing of the skin, mucous membranes and whites of the eyes. If all this is accompanied by signs of severe food poisoning, nausea and vomiting occurs, and body temperature rises - do not delay, this is an alarming symptom.

All hepatitis is a liver disease, and, although this is perhaps the most patient human organ, during an acute inflammatory process it makes itself felt. If the liver is visually enlarged and this is accompanied by any signs of discomfort in the form of pain, this is a compelling reason to consult a doctor.

The most insidious type of hepatitis is the “silent killer”, chronic hepatitis C. For quite a long time, an infected person may not notice any signs of this disease. Characteristic symptoms appear at the chronic stage of the disease, when the processes of liver damage have already gone quite far.

This is a carbohydrate metabolism disorder, which is characterized by constant elevated blood sugar levels. And like any deviation in pregnant women, it is not welcome due to possible complications.

In rare cases, pregnant women infected with hepatitis C have signs of cholestasis or, as it is also called, .

This phenomenon is associated with insufficient liver function and, as a result, a decrease in the flow of bile into the intestines. As a result of this failure, bile salts accumulate. All this leads to severe itching, most often at night. However, these phenomena disappear safely within two weeks after birth.

Pregnant women with hepatitis C may be at risk of developing preeclampsia, several percent more likely than a healthy woman. This extremely unpleasant phenomenon, characteristic of the late stage of pregnancy, is also called "late toxicosis".

Doctors, who for the most part are lenient about toxicosis of the first trimester, consider these manifestations to be quite dangerous and require treatment in order to avoid placental abruption and fetal death.

For the development of the fetus, “mother’s” hepatitis C can bring some troubles. The risk of premature birth and the birth of an underweight baby is considered a proven risk.

Such a newborn baby will certainly need increased attention and care.

Features of treatment of hepatitis C during pregnancy

If you are pregnant and have a positive reaction to antibodies to hepatitis C, or vice versa: if you are infected and “discovered” pregnancy, you need to understand that there will be certain nuances.

Contraindicated for pregnant women a number of drugs that are used in the treatment of hepatitis C. These necessarily include interferon and ribavirin. This is due to optional but possible risks of developing pathologies in the fetus. And the task of every doctor is to foresee even the hypothetical probability of such a risk occurring.

It is worth focusing on the obvious: a pregnant woman who has a history of hepatitis C and wants to give birth to a healthy child, You should absolutely not drink alcohol in any form.

This will almost certainly increase the risk of liver damage, which will affect your health and the serious percentage chance of late toxicosis. And this, in turn, can cause rejection, and as a consequence, the death of the fetus.

The second scenario is . Also, I must say, there is little good.

Ideally, you should also give up smoking, and complete this series of feats in the name of your unborn child by switching to a healthy and balanced diet.

Not recommended neither in the first nor in subsequent trimesters of pregnancy carrying out antiviral therapy. It involves the use of interferon-α and ribavirin, the undesirability of which has already been discussed.

There are cases when a pregnant woman with hepatitis C virus drug treatment may be indicated. This is the last trimester of pregnancy to reduce signs of cholestasis or to minimize the risk of developing preeclampsia.

2011-06-13T02:55:03+04:00

Hepatitis C during pregnancy

LLC Feron

Every expectant mother wants to have a healthy and strong baby. Therefore, many women undergo various examinations even before conception to eliminate the risk of transmitting any disease to the child during pregnancy or childbirth. One of the dangerous diseases that worries women is viral hepatitis C. Indeed, pregnancy and hepatitis C an extremely undesirable combination, since there is a high probability of infection of the fetus. Despite the fact that the hepatitis virus does not cause birth defects, some children are born with signs of inflammation in the liver. Doctors call hepatitis C the “soft killer” because acute symptoms of the disease may be absent or mild. But after some time, hepatitis becomes chronic, and then cirrhosis and even cancer develop.

Pregnancy and hepatitis C: features

When a woman becomes infected with hepatitis C during pregnancy, she may also not show signs of inflammation, or due to the mild severity of the manifestations, she may not pay attention to them. However, the virus gradually destroys liver cells, which sometimes leads to the development of intoxication and can cause miscarriage. According to various medical data, pregnancy can provoke an exacerbation of hepatitis C. If an exacerbation does not occur, the disease itself, as a rule, does not have a negative effect on the condition of the mother and fetus. Although, with a long course (more than 3-5 years), cases of miscarriage become more frequent in pregnant women. More than 90% of acute hepatitis C becomes chronic. The chronic form of hepatitis develops 6 months after infection and is characterized by periods of exacerbations and remissions (asymptomatic).

Intrauterine hepatitis infection

The hepatitis C virus is rarely transmitted to a child during childbirth; infection mainly occurs during pregnancy. In this case, the disease can cause delayed maturation of the placenta with a lack of oxygen in the fetus. It is worth noting that children born from mothers with hepatitis often have antibodies to the virus in their blood, which may disappear by the middle of the child’s second year of life. However, if they are detected after 18 months from birth, then this indicates infection. Hepatitis C in a baby will also be indicated by: increased liver enzymes, which indirectly reflect inflammation of the liver tissue; twice positive test for RNA virus (performed at the age of 3 and 6 months). The same genotype of the hepatitis C virus in mother and child can serve as confirmation of perinatal infection.

Treatment of hepatitis during pregnancy

Therapy of the disease should be carried out with the participation of several specialists: a hepatologist, an obstetrician-gynecologist and an immunologist. Treatment of viral hepatitis C in pregnant women is prescribed only when there are pronounced signs of the disease, since the height of the disease is accompanied by severe intoxication, which can lead to the loss of the baby. In other cases, doctors adhere to the tactics of monitoring the condition of the mother and child. The point is also that the main specific antiviral drugs that are prescribed for hepatitis C are contraindicated during pregnancy due to side effects, in particular due to the high risk of developing congenital deformities in the fetus. Some doctors also refuse to use parenteral interferons, since due to numerous side effects they are contraindicated for use during pregnancy.

Pregnancy and hepatitis C: modern therapy

Russian scientists have developed a drug that has successfully passed many years of clinical trials, has extensive experience of successful use in the combined treatment of hepatitis C, and is used from 14 weeks of pregnancy. The drug belongs to the class of recombinant interferons with an active protein compound in its composition - alpha-2b interferon, which has pronounced antiviral and immunomodulatory properties. VIFERON® also contains a complex of natural antioxidants that enhance the antiviral effect of the main active ingredient. During pregnancy, such women with hepatitis are also prescribed hepatoprotectors (medicines to maintain liver function) and a strict diet, which prohibits eating fried, spicy, fatty and salty foods, as well as consuming strong and invigorating drinks.

IMPORTANT

Many women with hepatitis C are afraid of becoming pregnant and having children. It is worth noting that the disease is not a contraindication to normal conception, gestation and birth of a baby. Thanks to modern comprehensive methods of prevention and treatment of hepatitis, including the use of Viferon, the risk of developing an acute process and complications is sharply reduced. The main thing is to closely monitor your health during pregnancy and undergo examination (routine or as prescribed by a doctor) for the presence of antibodies to the virus and viral markers in the blood serum. This will make it possible to identify the activity of the hepatitis C virus, prescribe adequate therapy, which will help a woman more easily cope with the disease during pregnancy and prevent the possibility of infecting the child.

Based on materials:

1. “Viferon against HCV”, (experience of use), V.A. Maksimov, V.A. Neronov, S.N. Zelentsov, S.D. Karabaev, A.L. Chernyshev.

2. Chronic viral hepatitis in children.” Methodological recommendations/Voronezh. GMA, comp. S.P. Kokoreva, E.A. Zhuravets, L.M. Ilunina.