Hepatitis B in Pregnancy

If you are a female and you are a hepatitis B carrier, is it alright to become pregnant?

The answer is yes. However, you need to take extra precaution during pregnancy and delivery.

Hepatitis B is mainly transmitted through contact with blood, where it is present in high concentration. Other body fluids like saliva, semen, vaginal discharge etc contain less concentration of the virus.

First of all, the spouse of hepatitis B carrier need to check his hepatitis B virus and antibody status. If he is not a carrier and does not have the antibody, then he needs to get the 3 doses of hepatitis B vaccination at the interval of 0, 1, 6 months. When he gets the antibody, viral transmission during sexual intercourse with his carrier wife can be prevented. However, the antibody level may wean off with time and he should check its level regularly.

When a woman who is also a hepatitis B carrier conceive, pregnancy is to continue as usual. Examination and blood test are done to make sure that she does not already reach the stage of chronic liver damage.

If a woman with no known hepatitis B status first found to be infected during pregnancy, then the possibility of an acute infection need to be ruled out. If acute infection occurs in the first trimester, there is a 10% risk of transmission of virus to the baby. If it occurs in the third trimester, the risk is 80-90%. The incubation period of hepatitis B can range from 6 weeks to 6 months.

Generally, the risk of transmission of hepatitis B virus from a carrier mother to her baby is about 10-20%. If immunoprophylaxis (hepatitis B immunoglobulin - HBIG) is given to the baby soon after birth, the risk can be significantly reduced. Thus, every baby born by a hepatitis B carrier mother will receive a dose of HBIG and a dose of hepatitis B vaccine within 12 hours after birth. The vaccine need to be continued for another 2-3 doses later.

Normal vaginal delivery does not significantly increase the risk of hepatitis B virus transmission to the baby compare to Cesarean section. Breast feeding should be allowed and encouraged, as long as the baby get the HBIG and vaccination.

    Hepatitis B virus

If unfortunately the newborn is infected with hepatitis B virus, there is a high chance (90%) that the baby will become a carrier. Not everyone infected will become a carrier. For children between 1-5 years old, the chance to become a carrier is 30%, while for adults, the chance is about 5%. Nevertheless, hepatitis B virus usually does not cause other problems such as malformation or organ malfunction to the infected baby.

If you are not a hepatitis B carrier and would like to get  hepatitis B vaccination during pregnancy, you can do so as the vaccine is reported as safe when given during pregnancy.

Vanishing Twin: Take it easy

Vanishing twin syndrome is when one of your twin baby just disappears in your womb during the course of pregnancy. It can also represent one or more babies lost in triplet, quadruplet or more.

This syndrome becomes more widely identified with the use of early pregnancy ultrasound scan. It occurs when an early ultrasound scan reveals 2 or more babies but a later scan shows less than that. The loss of fetus (baby in womb) can happen at any point of pregnancy. It can be in the first, second or third trimester. Generally, the earlier it happens, the better the outcome to the viable fetus and mother. Some research reveals that about 10-15% of single baby born are initially twins.

    Fetus papyraceus

 

No one knows exactly what causes vanishing twin syndrome. It is believed that the vanished fetus has some chromosomal or genetic defect and is aborted for good. The viable twin has normal chromosome and usually no other abnormality, but may have increased risk of cerebral palsy if it occurs after the second half of pregnancy. For mother side, there is some risk for complication if it happens later in pregnancy, such as preterm labour, infection of the retained material, post-delivery bleeding, obstruction of labour etc. However, if vanishing twin syndrome occurs in the first trimester (<12 weeks), these complication are very unlikely.

Vanishing twin syndrome may cause some per vagina bleeding and/or lower abdominal discomfort. The vanished fetus can “disappear” completely, form part of the placenta or become “mummified” depends on at what stage it starts to disappear. Mummified fetus need close observation during the pregnancy as it has higher risk to cause complication.

So, don't panic or feel too sad if your doctor tell you that one of your twin just disappears. It is actually good as if the disappeared baby is born, it will give you more problems as it has genetic defect. If the phenomenon occurs in the first half especially first trimester, there should not be too much worry.

PUPPP -> PuPP-P -> PUPPY

If you are in the 3rd trimester of pregnancy and you feel very itchy all over the body and you see some rash, you may have PUPPP. PUPPP stands for Pruritic Urticarial Papules and Plaques of Pregnancy. What a long name! Luckily we can write or read as PUPPP. (Pruritus = itchy)

Though the name is long and sounds scary, PUPPP is completely a benign (not-serious) skin problem. It occurs in the third trimester (after 28 weeks) of pregnancy. It usually starts at the abdomen where there are striae (stretch marks) and spread to other areas. It seldom involves face, palms and soles.

The skin may have raised spots (papules) or patches (urticaria) of red rash. No one knows why it happens. However, what we know for sure is that it won’t affect the mother and the baby. It will resolve by itself 1-2 weeks after delivery.

    

 PUPPP: Dots and Patches of rash

The big problem is…. It’s very itchy and you can’t sleep well! For this, doctors will give you rather strong steroid cream to relieve the itchiness and redness. Use it sparingly when the itchiness is less serious. Anti-histamine and moisturizers may also be given though not as effective. Soaking in warm water may help some.

Nevertheless, not all itchy rashes in pregnancy are PUPPP. It can be allergy, eczema, infection etc.