Problemsspecial considerations Viral hepatitis

Viral hepatitis accounts for 40% of all liver disease associated with pregnancy. It is thought that pregnant women might be more susceptible to viral hepatitis because of their relatively immunosuppressed state.

• Hepatitis A is highly contagious and spread by the faecal-oral route. The incidence in pregnancy is unknown since many infections are mild, but is thought to be low in the UK.

• Hepatitis B is thought to infect up to 1:50 pregnant women in UK inner cities, in which there is a large immigrant population. It is readily spread by contact with blood and body fluids. Women who are known to have been exposed to intravenous drug use or to have had multiple sexual partners should be assumed to be at high risk of having hepatitis B, and appropriate precautions should be taken. Prostitutes are at particularly high risk, since many are using illegal drugs and working as prostitutes to fund their drug habit. Pregnant women have been screened for hepatitis B in the UK since 2000. There is a ~10% risk of developing chronic liver disease; this may be increased by co-infection with hepatitis D.

Hepatitis C is unusual in pregnancy in the UK; it is thought to be prevalent in 0.5-1% of parturients in inner cities. It is spread mainly by contact with blood, although sexual transmission may also occur. There is a ~5% risk of transmission to the baby during pregnancy/delivery and a 50-80% risk of developing chronic liver disease.

• Hepatitis E is similar to hepatitis A. It may cause serious infection during the last trimester and may also cause miscarriage. It is unusual in the UK.

Symptoms are non-specific, and include fatigue, general malaise, loss of appetite, nausea, vomiting, headache and pyrexia. There may be some abdominal discomfort. Overt jaundice only occurs in about a quarter of cases. Treatment is symptomatic, and in the majority of cases there is complete resolution of all signs and symptoms over the course of a few weeks. Women with significantly impaired liver function may be thrombocytopenic or have abnormal clotting studies. Renal function may also be impaired. In end-stage hepatitis, alteration in mental state may occur as a result of hepatic encephalopathy. There is no evidence that pregnancy affects the course of the disease nor that hepatitis has any significant effect on pregnancy in the majority of cases. For the small number of pregnant women

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who develop hepatitis C it has been suggested that maternal morbidity and mortality is higher than in the non-pregnant woman. However, this increased risk may be apparent, due to misdiagnosis of conditions such as fatty liver of pregnancy, rather than a genuine risk.

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