hbv q - all_mle

[ArchivalUser]

A HBsAg + pregnant lady delivers a baby. What is given to the baby after birth?

A pregnant lady, with an unknown status, comes to the delivery department in labor. How is the newborn managed?

[ArchivalUser]

****That was unknown HBsAg status.


Also,
What is the mode of vertical transmission of Hep B?
What is the mode of delivery in case of HBsAg positive mother?

[ArchivalUser]

If the pregnant lady is HBsAg +ve, give the baby 1 dose of Hep B Ig and 1 dose Hep B vaccine within 72 hrs of birth. Followed by 2 more dosed of vaccine at 2 and 6 months. The new born can be breastfed after receiving the vaccine and the Ig.

If the status is unknown I think we can do a HBsAg test on the mother. Since C.S is not indicated in Hepatitis B infection, we can wait for the report anyway and anticipate a vaginal delivery. And then manage accordingly after the status of the woman is known, i.e if HBsAg +ve manage as above, if not routine Hep B vaccine to be given.

Most vertical transmission are intrapartum via infected maternal secretions.

[ArchivalUser]

I have a similar question with varicella during pregnancy if anybody could help out!

1)What do u do if a woman gets varicella before 20 weeks of gestation? (period when risk of neonatal varicella may develop)

2) What do u do if she gets varicella like in the last 2nd or 3rd trimester but its not close to delivery?

3) What do u do is gets varicella and she delivers in that week? ( Here i know for sure, u give VZIG to both mother and the newborn to prevent fetal infection)

Just need help with 1 and 2. The options are
a) oral acyclovir or i.v acyclovir (if severe)
b) VZIg
c) first do a VZ antibody assay

[ArchivalUser]

Hepatitis B vaccination in newborn


IF MOTHER IS HBSAG - VE
*********************

1ST DOSE --------------------------- SOON AFTER BIRTH ,BEFORE HOSPITAL DISCHARGE


2ND AND 3RD DOSE -----------------BY 18 MONTHS OF AGE


IF MOTHER IS HBSAG +VE
**********************

1ST DOSE HBV VACCINE + IG ---------------------- WITHIN 12 HRS AFTER BIRTH ( TWO DIFF SITES)

2ND AND 3RD DOSES OF VACCINE------------------ BY 6 MONTHS OF AGE


IF MOTHERS STATUS IS UNKNOWN
***************************
If infant is < 2kg........ give both HBs Ag + HB Ig(within 12 hrs )

If infant is > 2 kg ........give HBsAg only (not HB Ig ) ...Till mothers status is known

Subsequently on testing

If mother is HBs Ag -ve...........Hb IG need not be given.

If mother is +Ve.................... you have to give HBIG.

thnx

[ArchivalUser]

@atp15

VARICELLA IN PREGNANCY
*********************

Majority are immune by adulthood .Meaning 90% have positive ig G titres against varicella and are immune.So if a pregnant women comes to you check her status.

If immune you do not need to do anything

If Non immune ( advise 3 things to her )

1) -----------------No vaccination in pregnancy

2)------------------avoid close contact with varicella

3)------------------recommend PEP with VZIG within 96 hrs after exposure


IF MOTHER DEVELOPS VARICELLA IN PREGNANCY
****************************************

What happens to mother ?
______________________

Mother might have an "uncomplicated" or "serious" infection


What should be done ?
___________________

If uncomplicated -------------- no strong recommendation for oral acyclovir though some consider giving it .

If complicated like pneumonia ------------- Rx with IV acyclovir


NOW WHAT HAPPENS TO BABY AND HOW TO MANAGE
********************************************

The risk of transplacental transmission if mother develops primary varicella is very low ( 0.5-4%)

If fetus gets infected (8-20 W gestation)------------ "congenital varicella syndrome " ...most will have limb defects ,cranial abnormalities etc

If newborn develops infection in perinatal period------------ Rx with 30 mg/kg ACYCLOVIR

To prevent Neonatal varicella ------- Rx with VZIG if mother develops varicella anytime 5 dys before to 2 dys after birth.

Hope this helps

[ArchivalUser]

Thank you very much goal!! You always make it nice and clear

Only thing i want to add is, if the mothers status is unknown with a newborn more than 2 kgs, do as goal has mentioned, but when the mother's status comes, give HBIG immediately, but not later than 7 days.

Mode of spread mainly is via the vaginal birth canal.
But the mode of delivery is always vaginal.

[ArchivalUser]

My pleasure friend ...hope you are doing good

GL for CK

[ArchivalUser]

thank u guys.

[ArchivalUser]

Thank you goal. Was a pretty long break after step 1, trying to get back in track now.

Wish you all the very best to CK too