HBV in pregnancy, for elective Caesarean Section

PIG Meeting: 24th June 2021

33yo female for repeat CS


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


  • 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.