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    Perinatal Nursing: Day 2 online discussion

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    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 9:59 pm

    The treatment of acute HBV infection is supportive.Persons with chronic hepatitis B should be referred to health-care professionals with experience in the treatment of hepatitis B for treatment with alpha-interferon or lamivudine. Interferon does not appear to adversely affect the embryo or fetus. However, the data is limited, and the potential benefits of interferon use during pregnancy should clearly outweigh possible hazards. Initial data do not suggest that Lamivudine is teratogenic. Lamivudine has been used in the latter half of pregnancy in attempt to prevent perinatal transmission of hepatitis B virus infection with mixed success.

    Antepartum
    Pregnant Hepatitis B carriers should be advised to
    Obtain vaccination against hepatitis viruses A as indicated.
    Abstain form alcohol use
    Avoid hepatotoxic drugs such as acetaminophen (Tylenol) that may worsen liver damage.
    Not donate blood, body organs, other tissue, or semen.
    Not share any personal items that may have blood on them (e.g., toothbrushes and razors).
    Inform the infants pediatrician, OB/GYN, and labor staff that they are a hepatitis B carrier.
    Make sure their baby receives hepatitis B vaccine at birth, one month, and six months of age as well as H-BIG at birth.
    Be seen at least annualy by their regular medical doctor.
    Discuss the risk for transmission with their partner and discuss the need for counseling and testing
    b. Liver function testing is recommended for women who test positive for HBsAg [1]

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 9:59 pm

    Most women with chronic HBV infection have mild liver disease during pregnancy, although hepatitis may flare after delivery, as described above. In addition, interferon, lamivudine, adefovir and entecavir are classified by the Food and Drug Administration as Class C, and telbivudine and tenofovir as Class B.
    In most cases, this is because there are insufficient data in humans to demonstrate teratogenic or embryotoxic effects.
    For these reasons, in most instances, it is reasonable to defer therapy until after delivery, to avoid fetal exposure to the therapeutic agents. After delivery, standard therapy indications, as expressed in the several available HBV guidelines, will apply. However, if maternal liver disease requires treatment, or if a pregnancy occurs in a woman already receiving a medication for HBV, decisions must be made about treatment course.

    Hepatitis B and Pregnancy: An Underestimated Issue: Vaccination Against Hepatitis B Virus During Pregnancy and Treatment for Hepatitis B Virus During Pregnancy
    Maureen M. Jonas
    Published: 04/24/2009

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for the management..

    Post  ara_portillo on Tue 11 Aug 2009, 9:55 pm

    well.. if this pertains to the woman after delivery, thorough assessment should be done first to note the extent of the woman's condition.based from the assessment results, the proper management will be undertaken..

    management if ever the woman knows her condition during pregnancy would be supportive one. according to the CDC guidelines, possible treatment also will be the use of alpha-interferon or Lamivudine. some data suggests that this is not teratogenic.

    ma. cristina arroyo

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    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:52 pm

    Exposure to HBV during pregnancy

    If the women is detected of the HbsAg in the serum, a course of vaccine should be given whether the contact has been prolonged or only recent. The use of Hb vaccine during pregnancy is not recommended by the manufacturers but there is no evidence of any risk. on the other hand, there is a risk of prematurity and infection of infant if acute hepatitis occurs in the mother. ( Gilbert, 1991)

    Angel Ve
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    Re: Perinatal Nursing: Day 2 online discussion

    Post  Angel Ve on Tue 11 Aug 2009, 9:51 pm

    Yes.. they solely rely on history given by the family care physician, no tests were done to confirm their verbalization..

    Althea Perez

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    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 9:47 pm

    they solely rely on the verbalization of the significant others regarding the previous hepatitis screen test. They did not even wonder the duration of hepatitis B to manifest.

    ara_portillo

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    for angel's case...

    Post  ara_portillo on Tue 11 Aug 2009, 9:47 pm

    well, definitely, the hospital is not quite aware of the required screening schedule for HBsAg....

    ma. cristina arroyo

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    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:46 pm

    angel, maybe the health care professionals overlooked the condition. proper and comprehensive history taking was not done.

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 9:46 pm

    did she have her prenatal check ups? db. she should have a serology tests on diseases such as hep b? in the US, they do that as a protocol...whether the mother is tested negative before...

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:42 pm

    Ideally she should have been tested in the first trimester and that testing should be repeated late in pregnancy for those women who tested negative if they have clinical and laboratory evidence of hepatitis or have ongoing risk for acquiring HBV infection

    Angel Ve
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Angel Ve on Tue 11 Aug 2009, 9:42 pm

    Yes.. Pregnant women should be tested at the first prenatal visit for hepatitis B surface antigen (HBsAg). Women admitted for delivery who have not had prenatal HBsAg testing should have blood drawn for testing.

    Are you girls wondering why in this case the woman was not screened for HBsAG?

    ma. cristina arroyo

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    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:40 pm

    HbsAg Testing


    All pregnant women should be tested routinely for HBsAg during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been previously vaccinated or tested.


    Women who were not screened prenatally, those who engage in behaviors that put them at high risk for infection (e.g., injection-drug use, having had more than one sex partner in the previous 6 months or an HBsAg-positive sex partner, evaluation or treatment for a sexually transmitted disease [STD], or recent or current injection-drug use) and those with clinical hepatitis should be tested at the time of admission to the hospital for delivery.

    (Mast, 2003)

    ara_portillo

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    testing for HBsAg....

    Post  ara_portillo on Tue 11 Aug 2009, 9:39 pm

    According to some literatures, the test for HBsAG should have been done as early as possible during the first prenatal check-up, then it should have been repeated before delivery...

    The following are the guideline from the CDC of whom to test:

    • Test all pregnant women at the first prenatal visit for hepatitis B surface
      antigen (HBsAg).
    • Women admitted for delivery who have not had prenatal HBsAg testing should
      have blood drawn for testing.
    • More than 90% of women found to be HBsAg-positive on routine screening will
      be HBV carriers, routine follow-up testing later in pregnancy is not necessary
      for the purpose of screening. In special situations, such as when the mother is
      thought to have acute hepatitis, when there has been a history of exposure to
      hepatitis, or when particularly high-risk behavior such as parenteral drug abuse
      has occurred during the pregnancy, an additional HBsAg test can be ordered
      during the third trimester
    • Test all susceptible contacts (including all family members) with hepatitis B
      panel (HBsAg, antiHBc, antiHBs).
    • Screening and vaccination of susceptible contacts should be done by the
      family's pediatrician, primary health-care provider, or the physician evaluating
      the clinical status of the HBsAg-positive pregnant women.

    Reference: (Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines --- 2002 .MMWR May 10, 2002 / 51(RR06);1-80)

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 9:38 pm

    All pregnant women should be tested for the virus. The test should be done early enough in pregnancy to allow time to prepare treatment for the baby and to test family members if your test result is positive.

    American College of Obstetricians and Gynecologists. Hepatitis B Virus in Pregnancy. Copyright Clearing Center, 222 Rosewood Drive, Danvers, MA

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:38 pm


    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:36 pm

    to add..
    Approximately 90% of children infected during the perinatal period develop chronic infection, and up to 25% will develop chronic active hepatitis as adults. Susceptible children not infected in the perinatal period are at risk for infection from horizontal transmission of HBV in the first five years of life.

    Source:

    ma. cristina arroyo

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    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:34 pm

    Higher incidence of low birth weight among infants born to mothers with acute infection during pregnancy.

    In one small study acute maternal hepatitis (type B or nontype B) had no effect on the incidence of congenital malformations, stillbirths, abortions, or intrauterine malnutrition. However, acute hepatitis did increase the incidence of prematurity.

    It is now recognized that the chance of vertical transmission depends on the on the infectivity of maternal serum. about 90% of infants whose carrier mothers have Hbeag will be affected and most will become chronic carrier. (Gilbert, 1991)

    Angel Ve
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Angel Ve on Tue 11 Aug 2009, 9:33 pm

    ok.. So based from our researches, the child will really most likely to acquire Hepatitis if the mother is positive for HBsAG through vertical transmission.

    let's move to the next question

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    To add up..

    Post  ara_portillo on Tue 11 Aug 2009, 9:32 pm


    i agree.. to add up more...

    Sequelae of Being Born From a Mother With HBV

    Chronic infection occurs in about 90% of infected infants, 60% of infected children aged <5 years , and 2%--6% of adults. Among persons with chronic HBV infection, the risk of death from cirrhosis or hepatocellular carcinoma is 15%--25%. (Centers for Disease Control and Prevention Sexually Transmitted
    Diseases Treatment Guidelines --- 2002 .MMWR May 10, 2002 / 51(RR06);1-80)

    HBV infection does not appear to be teratogenic. However, there appears to be a higher incidence of low birth weight among infants born to mothers with acute
    infection during pregnancy. In one small study acute maternal hepatitis (type B or nontype B) had no effect on the incidence of congenital malformations, stillbirths, abortions, or intrauterine malnutrition. However, acute hepatitis did increase the incidence of prematurity (Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR November 22, 1991 / 40(RR-13);1-19).


    Last edited by ara_portillo on Tue 11 Aug 2009, 9:34 pm; edited 1 time in total

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 9:30 pm

    Yes, Pregnant women who are infected with hepatitis B can transmit the virus to their newborns during pregnancy or delivery. Almost 90% of these babies will become chronically infected with hepatitis B at birth if there is no prevention.

    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.

    Angel Ve
    Guest

    Case 4-answer 1

    Post  Angel Ve on Tue 11 Aug 2009, 9:28 pm

    In addition to your answers....

    According to a report issued by the Advisory Committee
    on Immunization Practices in the Morbidity and Mortality
    Weekly Report, infants born to mothers who tested
    positive for both the hepatitis B surface (HBsAg) and e
    (HBeAg) antigens faced a 70 to 90 percent risk of
    infection, with 85 to 90 percent of those infants
    becoming chronically infected. Infants born to mothers
    with the surface antigen and e antibody only faced a
    31 percent risk of HBV infection.

    Kukka HBV:Preventing Mother to-Child Hepatitis B
    Infection Available at: http://www.hcvadvocate.org/hepatitis/factsheets_pdf/HBV_mother.pdf

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 9:28 pm

    When a pregnant woman is infected with hepatitis B virus, there is a chance she will infect her fetus. Whether the baby will get the virus depends on when infection occurred. If it was early in pregnancy, the chances are less than 10% that the baby will get the virus. If it was late in pregnancy, there is up to a 90% chance that the baby will be infected.

    Hepatitis can be severe in babies. It can threaten their lives. Even babies who appear well may be at risk for serious health problems.

    Infected newborns have a high risk (up to 90%) of becoming carriers. They, too, can pass the virus to others. When they become adults, these carriers have a 25% risk of dying of cirrhosis of the liver or liver cancer.

    American College of Obstetricians and Gynecologists.Copyright Clearing Center, 222 Rosewood Drive, Danvers, MA 01923 (978) 750-8400

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:26 pm

    Infants at high risk of vertical transmission:

    -is hepatitis B e antigen positive, or
    -is hepatitis B surface antigen positive but without e markers, or
    -has had hepatitis B during pregnancy. (taylor and clark, 2009)

    Conversely sixty percent of pregnant women who acquire acute HBV infections at or near delivery will transmit the HBV virus to their offspring and mother to child transmission of hepatitis E virus infection was established between 33.3 and 50%. (Sookoian, 2006)

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    risks to the infant whose mother has HPV..

    Post  ara_portillo on Tue 11 Aug 2009, 9:25 pm

    Possible risk for the infant is the vertical transmssion of HPV:

    from MEDLINE (
    ACOG educational bulletin. Viral hepatitis in pregnancy. Number 248, July
    1998 . American College of Obstetricians and Gynecologists. Int J Gynaecol
    Obstet. 1998 ;63:195-202)
    >> 10-20% of women seropositive for HBsAg
    transmit the virus to their neonates in the absence of
    immunoprophylaxis. In women who are seropositive for both HBsAg and
    HBeAg vertical transmission is approximately 90%. In patients with
    acute hepatitis B vertical transmission occurs in up to 10% of neonates
    when infection occurs in the first trimester and in 80 -90% of neonates
    when acute infection occurs in the third trimester.

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 9:24 pm

    risks:

    * Infants born to HBsAg and hepatitis B e antigen (HBeAg) positive mothers have a 70% to 90% chance of becoming infected with HBV if not treated at birth.
    * As many as 90% of infants infected with HBV may become chronic carriers.
    * As high as 25% of these HBV carriers may die in adulthood from cirrhosis or liver cancer.
    * Perinatal transmission accounts for 4% of all acute cases of HBV infection.

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