> Disease in pregnancy: Hepatitis B, C and Aids

For a woman in pregnancy is of great importance come to know whether you è had a contact with the hepatitis B virus, hepatitis C and AIDS, as these diseases can be transmitted to the foetus:

    the

  • through the placental barrier
  • the

  • for direct contact at the moment of birth
  • the

  • breast-feeding

hepatitis B, hepatitis C and hiv / AIDS modeà transmission similar; the infection can; occur with:

    the

  • blood transfusions (even if by a few years, the used blood is carefully controlled);
  • the

  • exchange of syringes among drug users;
  • the

  • accidental contact with syringes, abandoned or other infected material;
  • the

  • sex with partner carriers of the virus.

it must Be stated, however, that the AIDS virus is less “durable” of hepatitis, and therefore relatively less contagious, or at least more easily sopprimibile through the implementation of appropriate hygiene measures. the what happens in the mother and in the fetus in these diseases, if contracted in pregnancy?

hepatitis B manifests the in pregnant woman with clinical characteristics similar to those of normal women.

it should Be pointed out that approximately 10% of patients who become infected with the virus do not develop the disease but become carriers healthy or suffering from chronic active hepatitis; hence they are potential sources of infection for other people così for the fetus, often without knowing it.

The passage of the virus through the placenta is possible for the whole pregnancy, but the risk of infection for the fetus is particularly high when the hepatitis maternal manifests itself in acute form in the last trimester of pregnancy; infection is also possible during the birth and with breastfeeding because the HBsAg is present in the milk in about 70% of the cases, but the transmission via the oral route requires a viral load very viral più high (the proof of contagion is the presence in the blood of the newborn of the specific antigen HBsAg or its appearance within six months).

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Many of the children infected from the virus and will become chronic carriers, some will develop mild forms of the disease, it is rare to find those destined to develop early a severe form of liver disease.

How to adjust today faced with a situation of this type? First of all, all pregnant women are subjected to tests for the detection of HBsAg and possibly other “makers” detectors specific for the disease and for hepatitis C.

All children born to mothers HBsAg positive, cioè potentially infected, are submitted to the preventive treatment with immune globulin and vaccine within the first 12-24 hours of life: the association of the vaccine with the gamma globulin can prevent infection of the newborn in 90-95% of cases and allows the mother to breastfeed the baby. With regard to the mother, the prevention is done only with immunoglobulin.

with regard To hepatitis C the percentage of infants from mothers HCV-positive who have contracted the infection is about 5-6%. This percentage increases significantly if the mother also has HIV infection (14-17%).

Contrary to what is observed for the transmission of HIV, in the case of HCV, the execution of the delivery by caesarean section is not è proved to be useful in reducing the risk of neonatal infection, così as not è been demonstrated that the transmission of infection through breastfeeding, which therefore is contraindicated.

with regard To AIDS , the risk of transmission of the virus from the mother to the fetus is estimated to be around 30 – 50% although there are some cases, with the percentage of transmission is very più high. In some of the centres are subject to a search (test) for hiv / AIDS only women belonging to the so-called risk categories.

    the

  • drug users
  • the

  • heterosexuals with many partners;
  • the

  • politrasfuse;
  • the

  • heterosexual who have sex with individuals belonging to the above categories.
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In other centres in the test runs to all pregnant women. Many, but not all women exposed to contact with the virus, infect it, becoming così “hiv-positive” cioè were healthy carriers of the virus in the blood of specific antibodies against the virus.

The maternal antibodies pass into the bloodstream of the fetus through the placenta and therefore the baby of an hiv-positive woman sarà definitely hiv-positive, that is; avrà the antibodies, but only 15-40% of them ammalerà of AIDS. The delivery by the use of caesarean section it is proved useful to reduce the risk of infection for the newborn.

These women così can be a source of contagion, while being healthy and often not aware of their status; a certain percentage svilupperà then, after a few years, the full-blown disease.

pregnancy can; worsen the clinical picture of the woman is infected, is hiv-positive, that già suffering from overt disease. With regard to the newborn, if infected, about 50% of the possibilitiesà to develop the full-blown disease within two years.

infection also increases to about three times the risk of miscarriage così as decreased development fatal and preterm birth.

The evidence of contagion has, however, only by searching for specific antibodies (IGM), and the virus in the blood of the umbilical cord of the newborn in the first months of life.

In conclusion, it is recommended that all women perform a test search for HIV (HTLV3) before a pregnancy.

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Page modified 10 February 2013