1. What risk/s does an infant born to a mother positive for HBsAg have?
The risk for an infant born to a mother positive for HBsAg is there’s a possibility that a newborn can acquire that virus from her mother which is transmitted during pregnancy or delivery. Almost 90% of these babies will become chronically infected with hepatitis B at birth if there is no prevention.
2. In the case, the mother was not immediately tested fro HBaAg. Ideally, when should pregnant women be tested for HBsAg?
Ideally, HBsAg testing should be done early in pregnancy and when other routine prenatal testing is done.
3. What is the correct medical management for this woman, having known that she was positive for HBsAg? If a pregnant woman tests positive for hepatitis B, then she should be referred to a liver specialist for further evaluation. Although most women do not have any pregnancy complications as a result of HBV infection, it is still a good idea to be seen by a specialist.
What is a possible adverse effect of treatment on the fetus? What happens to the baby if the vaccine is not received on time?
Women who present for delivery without prenatal care or without medical records documenting the results of HBsAg screening should have the HBsAg test done as soon as possible after admission, since delay in administration of HBIG to infants of carrier mothers will decrease the efficacy of therapy. In the studies that demonstrated the highest efficacy (85%-95%) of combined HBIG and HB vaccine prophylaxis, HBIG was administered within 2-12 hours after birth (2,4-6). In one study in which only HBIG was used for prophylaxis, no efficacy was found if HBIG was given more than 7 days after birth, and a significant decrease in efficacy was observed if it was given more than 48 hours after birth (16). Only one-third of U.S. hospitals currently perform the HBsAg test as an in-house procedure, and many of these have technicians who are trained to do the test available on only one shift. Hospitals that cannot rapidly test for HBsAg should either develop this capability or arrange for testing to be done at a local laboratory or blood bank where test results can be obtained within 24 hours.
1. Stevens CE, Beasley RP, Tsui J, Lee W-C. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975;292:771-4.
2. Stevens CE, Toy PT, Tong MJ, et al. Perinatal hepatitis B virus transmission in the United States: prevention by passive-active immunization. JAMA 1985;253:1740-5.
3. Beasley RP, Hwang L-Y. Epidemiology of hepatocellular carcinoma. In: Vyas GN, Dienstag JL, Hoofnagle JH, eds. Viral hepatitis and liver disease. Orlando, Florida: Grune & Stratton, 1984:209-24.
4. What are important considerations in handling and administration of hepatitis B vaccines.
Infants born to HBsAg-positive mothers should receive HBIG (0.5 mL) intramuscularly (IM) once they are physiologically stable, preferably within 12 hours after birth. HB vaccine, either plasma-derived (10 *gmg per dose) or recombinant (5 *gmg per dose), should be administered IM in three doses of 0.5 mL each. The first dose should be given concurrently with HBIG but at a different site. If vaccine is not immediately available, the first dose can be given within 7 days after birth. The second and third doses should be given 1 month and 6 months after the first. Testing the infant for HBsAg and its antibody (anti-HBs) is recommended at 12-15 months of age to monitor the effectiveness of therapy. If HBsAg is not detectable and anti-HBs is present, the child can be considered protected.
1. Stevens CE, Beasley RP, Tsui J, Lee W-C. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975;292:771-4.
2. Stevens CE, Toy PT, Tong MJ, et al. Perinatal hepatitis B virus transmission in the United States: prevention by passive-active immunization. JAMA 1985;253:1740-5.
1. Beasley RP, Hwang L-Y. Epidemiology of hepatocellular carcinoma. In: Vyas GN, Dienstag JL, Hoofnagle JH, eds. Viral hepatitis and liver disease. Orlando, Florida: Grune & Stratton, 1984:209-24.
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5. Upon knowing that a mother is positive for HBsAg, how will you care for her during the intrapartal period?
-I think we have to assist her for an appropriate counseling and medical management.
- Provide Health teaching about the mode of transmission, any perinatal concerns like breastfeeding, prevention of HBV transmission, including the importance of postexposure prophylaxis for the newborn infant and hepatitis B vaccination for household contacts and sex partners
6. What is the preferred method of delivery in pregnant women found positive for HBsAg? Why?
I think any method of delivery will do either nsd or cesarean section because there is still possibility of transmitting that virus to the baby.
7. Should breastfeeding be encouraged?
According to the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO), it is safe for an infected woman to breastfeed her child. All women with hepatitis B are encouraged to breastfeed their babies since the benefits of breastfeeding outweigh the potential risk of transmitting the virus through breast milk. In addition, since all newborns should receive the hepatitis B vaccine at birth, the risk of transmission is reduced even further.