PIG Meeting: 24th June 2021

33yo female for repeat CS

Background:

• HBV – reactivated during pregnancy. Risk of vertical transmission
• Albumin 30
• Ferritin 45
• Hb and platelet normal. 

Discussion

• Implications of HBV in pregnancy
  • Not uncommon for reactivation due to immunosuppressive state of pregnancy
  • As per RANZCOG:
    • Method of delivery shouldn’t be affected by HBV status
    • Invasive procedures which may breech the maternal/foetal blood barrier should be avoided (e.g., foetal scalp clip)
    • Breast feeding is not contraindicated provided appropriate immunoprophylaxis has been given at birth.
    • With high viral load in third trimester, appropriate to commence antiviral therapy to reduce risk of transmission to baby
    • Arrangements for passive (HBIG) and active immunisation of baby need to be in place.

• HBV testing
  • Noted that titres are reported in log multiples, therefore increasing levels represent exponential increase.

• Universal precautions should be used. Patient will still have high HBV titres and therefore high infectivity at time of CS.