A mother is Hbs Ag positive and anti Hbe Ag positive. Risk of transmission of Hep. B in child is:
20%
50%
0%
90%
Before answering these questions lets first discuss hepatitis in brief.
Maternal infection: The acute infection is manifested by flu like illness as malaise, anorexia, nausea and vomiting. In majority, it remains asymptomatic. Jaundice is rare and fever is uncommon.
Clinical course (HBV): Nearly 90–95% of patients clear the infection and have full recovery. 1% develop fulminant hepatitis resulting massive hepatic necrosis. 10-15% become chronic and 10% of these chronic cases suffer from chronic active hepatitis, cirrhosis and hepatocellular carcinoma.
Diagnosis is confirmed by serological detection of HBsAg, HBeAg (denote high infectivity) and antibody to hepatitis B core antigen (HBcAg) and HBV DNA titer (107–1011).
Screening: All pregnant women should be screened for HBV infection at first antenatal visit and it should be repeated during the third trimester for ‘high risk’ groups (intravenous drug abusers, sexual promiscuity, hemophilics, patients on hemodialysis or having multiple sex partners).
Hepatitis C (HCV):
It is recognized as the major cause of non-A, non-B hepatitis worldwide and is the leading cause of transfusion associated hepatitis. Transmission is mainly blood borne and to a lesser extent by faecal-oral route. It is responsible for chronic active hepatitis and hepatic failure.
Perinatal transmission (10–40%) is high when coinfected with HIV and HBV.
Detection is by antibody to HCV by EIA, which develops usually late in the infection.
Confirmation is done by recombinant immunoblot assay (RIBA-3).
Chronic carrier state is present. Breastfeeding is not contraindicated.
Hepatitis D (HDV):
It is seen in patients infected with HBV either as a co-infection or super infection. Perinatal transmission is known.
Hepatitis E (HEV): Hepatitis E is the most important cause of non-A, non-B hepatitis in developing countries like India. Chronic carrier state is present. Perinatal transmission is uncommon.
Maternal mortality is very high (15–20%).