With the right approach to conception, future parents undergo a complete examination at the stage of planning a child. The most common detection of hepatitis C virus occurs when a woman undergoes a full screening examination. Hepatitis C and pregnancy can live peacefully in the female body. Pregnancy in a woman with hepatitis does not aggravate the course of the disease.

Hepatitis C and pregnancy can peacefully exist in the female body

What is dangerous and sources of infection

Hepatitis C is the most severe in the group of hepatitis viruses. The main mode of transmission of the disease is through blood. Fresh and dried blood can be a source of infection. You can also get infected with the virus along with any other fluids of the human body - semen, saliva. Infection methods:

• when using non-sterile or poorly disinfected medical instruments;
• with blood transfusion;
• in tattoo parlors, manicure and pedicure rooms;
• with unprotected sex;
• from mother to child (vertical infection);
• in the process of labor.

The risk of infection of the fetus during gestation is 5%. The formation of antibodies in the mother's body inhibits the development of the disease in the child. If during gestation there are problems with the placenta, then the risk of infection of the fetus increases several times (up to 30%). The presence of HIV infection in a pregnant woman increases the likelihood of infection of the child. Infant infection can occur during childbirth. Moreover, the way in which a woman will give birth does not matter.

There are three ways of "vertical transmission" of the virus from mother to child:

• in the perinatal period;
• transmission during labor;
• infection in the postpartum period.

A baby can get hepatitis C after birth

If during the period of gestation and during childbirth, the child was not infected with hepatitis C, then there is a high probability of infection after birth. Since the baby is in constant contact with the mother. To prevent this from happening, mom needs to carefully monitor the condition of her skin, avoid cuts and injuries. And if a woman is injured, then avoid getting blood on the skin and mucous membranes of the newborn.

Hepatitis C in pregnant women does not affect the course of pregnancy. But the processes that take place in the mother's liver can provoke premature birth and hypertrophy in the fetus.

What to do if a pregnant woman is diagnosed with hepatitis C

For the entire gestational period, each woman is tested for hepatitis 3 times. If the result is positive, then the expectant mother will need to visit a doctor much more often, be under the close supervision of doctors and give birth in a separate infectious disease ward.

The patient may be prescribed medications for the liver, which are not contraindicated during gestation.

Symptoms and Diagnosis

In most cases, the disease proceeds without pronounced symptoms and does not manifest itself for a long time. There are general symptoms of the presence of the hepatitis virus in the body:

• the skin and eyes have become yellow;
• weakness;
• drowsiness;
• nausea and vomiting;
• temperature increase;
• pain under the ribs on the right side.

A woman may mistake some of the symptoms for ailments during pregnancy and not pay attention to them.

An accurate diagnosis can be made only after the expectant mother has a blood test for hepatitis (anti-HCV). Markers for the presence of hepatitis C virus are detected by blood immunofermentation.

To obtain the most reliable result for the presence of hepatitis C, the polymerase chain reaction method is used. The essence of the method lies in the multiple duplication of a selected DNA fragment using enzymes under artificial conditions.

Is a diagnostic error possible?

An error in the diagnosis of hepatitis C during pregnancy occurs in medical practice... Therefore, a woman must be tested again. In women in a position, the analysis for hepatitis can be false not only as a result of an error, but also for a number of reasons:

• the presence of diseases of an autoimmune nature;
• the presence of tumors;
• complex infectious diseases.

A positive indicator for hepatitis C can result from the presence of another virus in the body, so an additional examination is carried out:

For an accurate diagnosis of hepatitis C, an ultrasound of the liver is performed

• ultrasound examination of the liver;
• general blood test;
• ultrasound examination of the abdominal cavity;
• polymerase chain reaction method.

How is gestation going

Pregnancy with hepatitis C is not a death sentence for a mother or child... The effect that the disease can have on the fetus and the course of pregnancy depends entirely on its form and on the amount of viral RNA in the woman's blood. If the content of the virus is less than one million copies, then the woman will feel normal when carrying a child, and the likelihood of infection of the fetus is minimized.

The manifestation of chronic signs of the disease and the content in the blood of a high level (more than two million copies) of viral RNA carries the risk of not carrying a pregnancy and the development of pathologies in the fetus. The baby can be born prematurely.

If the virus was detected in a woman at the stage of pregnancy planning, then the disease should first be treated and six months later, after the withdrawal of drugs, conception should be started.

What is the danger of the virus

Hepatitis C from mother to child can be transmitted during intrauterine development, during childbirth and after childbirth. Fetal infection can occur if the protective barrier (placenta) is broken. When a baby is born, antibodies may appear in his blood. This fact should not cause much concern, since they usually disappear by the age of two. It is possible to detect infection after two years. An analysis for the presence of antibodies in a child of the first year of life is taken at one, three, six and twelve months.

If the child was not infected by the mother during pregnancy and childbirth, then whether the virus is transmitted later will depend on the mother's compliance with all precautions.

It is possible to give birth to a baby to a mother with hepatitis both naturally and by caesarean section. The method of delivery does not affect the likelihood of infection.

Pregnancy and maternal hepatitis can have a negative impact on the course of the disease. Since when carrying a child, the woman's body is weakened, the disease can turn into a more severe form. This is dangerous for both the mother and the baby. As a result of complications, a woman may develop a malignant liver tumor. A severe form of hepatitis C can adversely affect the development and vitality of the fetus, provoke premature birth, asphyxia and hypoxia in the newborn. The body of a baby who was born much earlier than the term is very weak, so the mortality rate among such children is up to 15%.

During the height of epidemics, the death rate of mothers with hepatitis is 17%. There may be complications after childbirth in the form of bleeding, which appear against a background of blood clotting disorders.

Treatment during gestation

To support the liver and reduce the risk of developing cirrhosis, the patient is prescribed mild drugs

Treatment of hepatitis C during pregnancy is carried out in the event of an exacerbation, in which case liver intoxication occurs, leading to abortion. With a calm course of the disease, doctors monitor the patient with frequent examinations and laboratory tests. Many medications used to fight hepatitis are prohibited during pregnancy.

To support the work and reduce the risk of developing cirrhosis of the liver, the patient is prescribed light drugs Hofitol, Essentiale, diet is recommended. It is important to eat properly while waiting for a child and if you have hepatitis C. You need to eat in small portions with short breaks between meals. The diet should be dominated by food that is easily absorbed and digested, products of plant origin.

An infected woman expecting a baby should avoid exposure to substances that poison the body: fumes of varnishes and paints, exhaust from cars, smoke, etc. Antibiotics and anti-arrhythmia drugs are prohibited.

Heavy loads leading to overwork, prolonged exposure to the cold are undesirable.

How is childbirth and what are the consequences

If hepatitis C was detected during pregnancy, then it is very difficult to assess the possible consequences for the baby. Since the baby may not be infected during childbirth. It is necessary to give birth according to the testimony of a doctor. What method of delivery is shown to a woman is the way to give birth. For hepatitis infection, the way the child is born does not really matter. But it is believed that a cesarean section reduces the risk of infection in a newborn. The doctor needs to inform the woman about the probable risks to the fetus, show the statistics of infection during spontaneous childbirth and using a cesarean section.

Patients with chronic hepatitis are sent to the infectious diseases ward for childbirth. If a woman has a non-viral form of the disease and did not have complications during pregnancy, then she can give birth in a general ward. Also, the expectant mother can lie in the general department of pregnancy pathology and expect childbirth.

There is no unequivocal opinion about breastfeeding of newborns. Studies have shown that in a number of cases, women with chronic HCV infection did not have breast milk contaminated. But according to the results of other experiments, the RNA of the virus in milk was found, but its concentration was low.

When the baby is born, the child infectious disease specialist monitors his condition throughout the year. The final examination is carried out after 24 months from the date of birth of the child, then it is possible to accurately determine whether he is infected or not.

After the birth of a baby, a woman may experience an exacerbation of the disease. 1 month after giving birth, a mother with hepatitis needs to have a blood test. Based on the results of laboratory tests, further actions should be planned.

Abortion for hepatitis C

Termination of pregnancy may be insisted by a doctor for medical reasons or in connection with a threat to the life of the mother

Since the course of hepatitis is asymptomatic, its detection occurs during routine tests when registering with an antenatal clinic. Future parents may be intimidated by such a diagnosis. Abortion in hepatitis C is contraindicated in exacerbation. If there is a threat of termination of pregnancy, then doctors try with all their might to save the child.

If a woman decides to terminate the pregnancy, fearing for the health of the baby, then an abortion is performed up to 12 weeks. But abortion can be done only after the completion of the icteric stage.

A doctor may insist on termination of pregnancy for medical reasons or in connection with a threat to the mother's life. I highlight the clinical indications for abortion:

• severe hepatitis and cirrhosis of the liver;
• placental abruption, bleeding;
• cancers requiring chemotherapy;
• acute neuroinfections;
• diabetes;
• danger of uterine rupture, etc.

Various types of abortion are used depending on the duration of pregnancy and the woman's health. Allocate:

• surgical method of termination of pregnancy;
• vacuum;
• abortion with medication (miscarriage occurs);
• abortion after thirteen weeks of pregnancy (difficult abortion).

Spontaneous abortion with hepatitis C occurs in 30% of cases.

With a mild form of the disease, hepatitis C is not an obstacle on the way to motherhood and you should go for an abortion only in extreme cases.

Video

Hepatitis C and pregnancy. Hepatitis C treatment and pregnancy planning.

According to medical statistics, which takes into account only registered cases of HCV, the number of people with such viral liver damage exceeds 300 million. But according to unofficial data, this figure is close to a billion people. Up to 60% of all liver damage is associated with chronic HCV infection. In this case, the pathology in most cases affects people aged 16-36 - physically active, fertile age.

Accordingly, such a problem as viral hepatitis C and pregnancy is extremely acute, especially given the frequent cases of late diagnosis and the impossibility of targeted therapy during the period of gestation.

Soon after conception, physiological inhibition of antibody production and viral replication occurs (if infection has already occurred). Thus, the level of specific immunoglobulins for HCV in the first trimester is below the threshold of sensitivity of many test systems used. Therefore, a one-time study for hepatitis C at the initial stages of gestation is not indicative.

The high probability of infection is due to a decrease in the mother's immune defense as the child develops in utero. This creates optimal conditions not only for infection, but also for the rapid replication of the virus. For this reason, a second test for hepatitis C in pregnant women is carried out closer to the date of delivery (usually at 28-32 weeks, before going on maternity leave.

The physiological stress on the liver during fetal development should not be underestimated. To neutralize the waste products of the child and provide him with plastic material, all the functional reserves of the organ are mobilized. The volume of circulating blood increases by 40%, the production of many biologically active substances, especially estrogens and progesterone, increases. During this period, deviations from the norm in liver function tests are perceived by some doctors as a variant of the body's adaptation to a new state.

The highest incidence of HCV in pregnant women is observed in risk groups. So the combination of HIV and hepatitis C during pregnancy is recorded in 54% of cases.

Previously, a mandatory study by ELISA for viral liver damage was prescribed only to certain categories of women:

• who have undergone blood transfusions (until 1992, when accurate methods of detecting Hepatitis C virus in biological material appeared);
• with concomitant HIV and / or hepatitis B;
• addicted to intravenous drug use;
• having sex partners infected with the virus;
• regularly undergoing hemodialysis;
• organ transplant recipients, etc.

Currently, research is mandatory for everyone, regardless of risk group or social status. But even in countries with a developed health care system, hepatitis C is detected before pregnancy only in 1/3 of cases. In the vast majority, the diagnosis occurs after conception, when effective antiviral therapy is not possible due to the high risk to the developing fetus.

Prenatal HCV diagnosis

Existing protocols include a full description of both the timing of when to take tests for hepatitis C, and a list of recommended diagnostic methods. Currently, two main types of research are used - molecular and serological. The former are designed to detect the RNA of the hepatitis C virus, the latter - to detect antibodies released when HCV enters the body.

In a clinical laboratory, immunoglobulins are determined by enzyme immunoassay (ELISA) in plasma or serum. But in 2017, rapid tests appeared on the pharmaceutical market to determine antibodies to HCV in human saliva. Confirmatory for ELISA diagnostics is a study by the method of recombinant immunoblot (RIBA). The specificity of the test systems used today reaches 90%.

Polymerase chain reaction (PCR) detects both the presence of HCV (qualitative analysis) and the level of viremia (quantitative detection). The specificity of this research technique exceeds 97%, which makes PCR one of the most reliable methods for diagnosing hepatitis C in any category of patients. A false positive analysis is only possible if the technician or the quality of the equipment is mistaken.

Modern test systems used to formulate the polymerase chain reaction allow the determination of HCV RNA at a level of 10-50 IU / ml (with qualitative PCR) and 25-7 IU / ml for a quantitative assessment of viral load. Some highly sensitive techniques allow to immediately identify indicators of viremia, bypassing the stage of qualitative determination of the presence of the hepatitis C virus.

Genotyping is mandatory after confirming the diagnosis. But in isolated cases (less than 5% of pregnant women), it is not possible to establish the type of HCV.

After confirming the diagnosis, the doctor decides on a puncture liver biopsy.

The manipulation is performed under anesthesia that is safe for the fetus, but according to strict indications. These include:

• the inability to determine the time of infection;
• hCV genotypes characterized by rapid progression and risk of complications;
• non-informativeness of non-invasive diagnostic methods (elastometry, ultrasound);
• suspected hepatocellular carcinoma;
• a woman's desire to have a biopsy.

It is advisable to conduct the study before starting therapy. The identification of pathologies such as steatosis, iron accumulation do not interfere with the appointment of antiviral drugs, but determine the further prognosis of the development of pathology. When cirrhosis or liver cancer is detected, a decision is made about the safety of maintaining pregnancy (for both the woman and the child).

Mode of transmission and risk group

The main route of transmission of HCV infection is direct contact with contaminated blood or its dried drops (the virus remains viable for up to 4 days). Less commonly, the disease is transmitted through sexual contact and it is almost impossible to get infected with ordinary kisses.

The following categories of women fall into the risk group:

• medical workers who are constantly in contact with blood;
• addicted to injecting drugs;
• promiscuous sex workers;
• the wife or female partner of infected patients;
• undergoing frequent invasive medical procedures.

But the analysis for hepatitis C is a mandatory part of the examination that every pregnant woman undergoes.

Symptoms and signs

Some of the most common manifestations of HCV include:

• asthenic syndrome occurs in almost all women in position, but often this symptom is regarded as a natural manifestation of pregnancy and is not associated with the underlying disease;
• dyspeptic syndrome (noted in 40-50% of cases);
• hepatosplengomegaly (found in 35-40% of patients), sometimes the syndrome is caused by heredity;
• an increase in the level of liver enzymes and bilirubin (registered in 50-52% of cases);
• cholestasis with concomitant digestive disorders (occurs in 20-25% of patients).

But in some patients, the level of ALT and bilirubin remains within normal limits throughout the entire period of gestation. Extrahepatic manifestations of HCV during pregnancy usually include antiphospholipid syndrome and mixed cryoglobulinemia.

If during pregnancy tests showed hepatitis C, such laboratory signs indicate an unfavorable prognosis:

• hemorrhagic syndrome;
• swelling;
• ascites;
• increasing the concentration of total bilirubin up to 200 μmol / l and more;
• decrease in the level of total protein and other indicators of protein metabolism;
• decrease in prothrombin index (up to 50% or less) and fibrinogen.

When such signs and symptoms are detected, a woman needs constant monitoring of the condition, control of the vital parameters of the fetus. When the risk of complications is too high and requires immediate initiation of therapy, a decision is made about the possibility of terminating the pregnancy for medical reasons.

Errors in analyzes

Sometimes during pregnancy, ELISA is positive, but this does not always indicate the presence of infection in the mother. During the period of gestation, the work of the human immune system is completely rebuilt, the release of specific proteins begins, which distort the data of the enzyme immunoassay.

Therefore, a positive ELISA result always requires confirmation and additional diagnostics. To exclude infection during pregnancy or before conception, a qualitative and quantitative study is prescribed by the method of staging a polymerase chain reaction.

Detection of HCV by PCR is almost 100% confirmation of the diagnosis. In this case, it is necessary to take tests for various concomitant pathologies, assess the state of the liver. With a minimal viral load, pregnancy can be maintained.

Is it possible to get pregnant with hepatitis C

Women with diagnosed HCV infection often ask their doctor if it is possible to become pregnant with hepatitis C. According to animal experiments and clinical experience, HCV does not affect a woman's fertility. However, the risk of early miscarriage is 20%.

But taking into account the negative influence of the disease on the formation of the child, the lack of adequate methods of therapy and control of the replication of the pathogen during the period of intrauterine development of the fetus, the answer to the question, it is possible to plan a pregnancy with hepatitis C, is negative. Opportunities now exist to effectively treat HCV, with therapy typically lasting no more than 24 weeks.

If, six months later, and then 48 weeks after the end of the medication intake, high-quality PCR confirms the absence of the virus in the body, unpleasant consequences for the fetus, a threat to the health of the woman herself, can be excluded. In this case, a safe pregnancy is possible.

Is it possible to conceive safely if the husband has HCV?

You should also refrain from planning a pregnancy if your partner is diagnosed with HCV infection. Sexual transmission of the virus is unlikely, but possible, so it is imperative to use a condom during sex. If there is a pregnancy from a man with hepatitis C, blood is donated for HCV by ELISA and PCR.

If a woman has not found the virus, it is necessary to observe the strictest preventive measures using barrier methods of contraception during intercourse, protection from accidental ingestion of contaminated blood into the body. The man is prescribed antiviral therapy and appropriate studies to assess the condition of the liver. Hepatitis C in a husband and pregnancy are quite compatible, provided that the woman and the baby are protected from infection after childbirth.

Features of the course of hepatitis C during pregnancy

Usually, hepatitis C during pregnancy occurs with severe clinical symptoms due to the increased load on the liver. A woman usually complains of severe fatigue and indigestion. But the same manifestations are considered quite normal for a pregnant woman. But if asthenic syndrome, weakness and sleep disturbances progress, this is a reason to suspect hepatitis C.

Chronic form

Chronic hepatitis C is more commonly diagnosed. Usually, the disease is anicteric. Often, the only characteristic of HCV is constant tiredness and fatigue. After eating "heavy" foods (smoked meats, fatty foods, fried foods), there is a dull pain or a feeling of fullness in the right hypochondrium. Stool disorders are often noted.

Acute form

The acute period of HCV infection in pregnant women can occur against the background of the following symptoms:

• jaundice (occurs in 20% of cases after a 1-2 week incubation period);
• asthenovegetative syndrome;
• fatigue;
• weakness;
• shortness of breath and palpitations at the slightest physical exertion;
• decreased appetite;
• nausea;
• vomiting;
• periodic episodes of temperature rise to 37.5-38 °;
• a feeling of discomfort in the right hypochondrium.

Symptoms of cholestasis are also possible - discoloration of urine and feces, belching with a bitter taste in the mouth. The intensity of clinical signs increases with non-compliance with a strict diet, alcohol consumption, even in small amounts.

Carrier

Currently, the term "carrier" of viral hepatitis C is practically not used. The definition of the latent course of HCV is more often used, that is, without any pronounced clinical symptoms. This form of the disease is characterized by the slow development of complications from the liver or the absence of changes in the structure of the hepatic parenchyma.

But pregnancy with carriage is a factor that triggers the onset of the active replication phase of the virus. Nevertheless, in 60% of women, HCV is diagnosed during tests, which are submitted at the stage of registration with a gynecological consultation. With a high degree of probability, the pathology will begin to progress, which can negatively affect both the course of pregnancy and the intrauterine development of the fetus.

Can the virus be transmitted to the fetus

When asked whether HCV infection is transmitted from mother to child, doctors do not give a definite answer. By inheritance, the virus does not pass to the newborn. Some experts even argue that hepatitis C cannot be transmitted vertically. Others cite data from clinical experiments, according to the results of which the probability for a fetus to become infected in utero ranges from 3 to 10%.

Hepatitis C is transmitted to a child during pregnancy in the presence of the following risk factors (presented in the table):

Coinfection with HIV	The concomitant presence of the human immunodeficiency virus increases the likelihood of vertical transmission of HCV by 2-3 times. Antiretroviral drugs are prescribed to prevent infection
With low viremia, the likelihood of intrauterine infection is minimal. With a high viral load, the risk of vertical transmission increases significantly. But there is not enough information on the possibility of changing the parameters of viremia depending on the gestational age. There is evidence from medical research indicating an increase in viral load in the 3rd trimester. In other sources, positive PCR results shortly after conception were noted in 37% of women, but by the end of gestation, negative PCR was obtained in 18% of patients
Injecting drug use	An asocial lifestyle reduces adherence to therapy, creates conditions for the addition of other viral infections
Gestation period	There is no data confirming the dependence of the risk of infection on the date of birth of the child
Baby gender	According to medical statistics, girls are infected 2 times more often than boys. The same data was obtained when studying the statistics of intrauterine transmission of HIV. The exact mechanism of this dependence is unknown.
Method of delivery	Reducing the infant's exposure to the mother's contaminated blood also reduces the likelihood of infection. However, the presence of hepatitis C (without HIV coinfection) is not a strong indication for a caesarean section, but surgical delivery is strongly recommended
Obstetric manipulations during pregnancy	The likelihood of HCV transmission to the fetus increases when using obstetric forceps during childbirth, performing an amniocentesis procedure (puncture of the fetal bladder for diagnostic purposes)
Breast-feeding	Despite controversial clinical trial data, hepatitis C is not a lactation-transmitted infection. According to experts, infection is more likely if an acute form of HCV is found during the period of gestation or with a high viral load. Doctors also pay attention to bleeding from cracked nipples, which greatly increases the likelihood of infection.

Hepatitis C cannot be inherited. This term is used for genetically determined pathologies. However, there is a risk of vertical transmission.

Treatment of the disease during pregnancy

After receiving positive test results, many women are interested in how to treat hepatitis C during pregnancy. But there are no effective and at the same time safe methods of HCV therapy for fetal development. Direct-acting antiviral drugs prescribed in standard protocols are contraindicated during gestation due to lack of clinical safety data. Some drugs in experiments on animals have shown pronounced teratogenic and embryotoxic effects.

Therefore, hepatitis C during pregnancy is treated symptomatically. Be sure to prescribe hepatoprotectors (both synthetic and phytopreparations based on natural ingredients). Also shown is antioxidant therapy, vitamin complexes to prevent placental insufficiency.

But in no case suitable drugs should be selected based on reviews on forums or on the advice of loved ones. Treatment of HCV during the period of gestation should be carried out only by a doctor based on anamnesis data, possible burdened heredity and the results of clinical studies.

Childbirth and HCV

If a woman is diagnosed with hepatitis C, pregnancy and childbirth should be monitored by an experienced doctor. In the course of clinical studies, experts collected information about the dangers of HCV for women and children, both during intrauterine development and after birth.

The doctors concluded that the risk of vertical transmission does not exceed 7-10% and even less if the virus is detected in the 3rd trimester and the number of copies of HCV RNA is small. But it is possible to diagnose a child only after childbirth, so the task of doctors is reduced to minimizing the contact of a newborn with the blood of an infected mother.

Hepatitis C, pregnancy and childbirth are quite compatible, and infection of the newborn can be avoided, but all the doctor's instructions should be carefully followed. The woman is strongly encouraged to agree to have a caesarean section. At the same time, medical personnel, neonatologists are warned about the risk of infection.

How hepatitis C affects pregnancy is determined through regular tests and examinations that the doctor prescribes for the patient. With a high risk of intrauterine hypoxia, the development of preeclampsia, placental insufficiency and other complications, premature delivery is recommended to avoid irreversible malformations of the child.

Breast-feeding

It is not fully established whether the virus is excreted in breast milk. According to some clinical studies conducted in Europe and Germany, the probability of infection is present, but does not exceed 0.8-0.95%. However, during the initial period of lactation in women, cracks often appear on the nipples, and each feeding is accompanied by the release of blood - the main source of infection.

Therefore, as soon as a woman with hepatitis C becomes pregnant, she is warned about excluding lactation and transferring the child to artificial feeding immediately after birth. In addition, if HCV is found after conception, antiviral therapy is prescribed after childbirth, which is also incompatible with lactation.

Possible complications and consequences for the child

If hepatitis C is diagnosed during pregnancy, it is possible to assess the consequences for the baby and harm to the body only after childbirth. Without exception, all infants born to infected women have maternal immunoglobulins in their blood, which enter the placental bloodstream. Therefore, diagnostic tests by ELISA are not indicative.

In this case, anti-HCV antibodies can persist for up to one and a half years, and this is not a sign of infection. Clinical trials are currently underway regarding the question of whether maternal immunoglobulins protect the fetus from intrauterine infection.

Diagnosis of hepatitis C in an infant is carried out at the age of three and six months by the method of polymerase chain reaction. It is imperative to repeat the analysis regardless of the result. Performing ELISA is advisable in children who have reached one and a half years.

When infected in the perinatal period, chronic hepatitis C often develops, characterized by a latent latent course. Extrahepatic manifestations are extremely rare. Virus activity is low, histological changes in liver tissue are insignificant.

There is no information on long-term prognosis of the course of hepatitis C in infants infected during intrauterine development or during delivery. It is believed that cirrhosis, like the next stage of complications - hepatocellular carcinoma, occurs in adulthood. But the course of the disease is aggravated by coinfection with other types of hepatitis. Therefore, vaccination is mandatory.

It is very important to monitor the course of treatment for HCV infection in a woman in order to avoid infection of the baby in the postpartum period.

Prevention of infection during pregnancy

During pregnancy, a woman has to undergo a number of tests and undergo many studies, including invasive ones. To avoid infection, it is necessary to monitor the sterility and use of disposable instruments. It is also recommended to refrain from visiting beauty salons, and to use your own tools for manicure and / or pedicure.

The period of pregnancy is not suitable for experiments with tattoos, casual sex. The use of other people's hygiene items (razors, tweezers, epilators, etc.) is strictly prohibited. You should also visit proven dental offices, where due attention is paid to the rules of asepsis.

Hepatitis C and pregnancy are a combination that scares expectant mothers. Unfortunately, these days, this diagnosis is more and more often found during the gestation of a child. The disease is diagnosed using standard screening for infections - HIV, hepatitis B and C, which all expectant mothers undergo. According to statistics, pathology is found in every thirtieth woman in our country, that is, this disease is quite common.

Very little is known about the interactions between chronic hepatitis C and pregnancy these days. It is only known that the consequences of this condition may be miscarriage and premature birth, the birth of a child with insufficient body weight, infection of the fetus during childbirth, the development of gestational diabetes in the expectant mother.

Hepatitis C is a viral liver disease. The virus enters the human body mainly through the parenteral route - through the blood. Signs of hepatitis C infection usually appear in an erased form, therefore, the pathology, remaining unnoticed at a certain moment, easily turns into a chronic process. The prevalence of hepatitis C among the population is growing steadily.

The main routes of infection:

• blood transfusion (fortunately, in recent years this factor has lost its significance, since all donated plasma and blood are necessarily checked for the presence of the virus);
• unprotected sexual intercourse with a virus carrier;
• using a syringe after a sick person;
• non-observance of personal hygiene standards - joint use of razors, nail scissors, toothbrushes with a carrier of the virus;
• infection with contaminated instruments when piercing and tattoos are applied to the skin;
• professional activities related to blood - infection occurs accidentally, for example, during hemodialysis;
• infection of the fetus during its passage through the birth canal.

The virus is not transmitted by household contact and airborne droplets.

The risk group for contracting hepatitis C includes:

• people who underwent surgery before 1992 inclusive;
• health workers who regularly work with people infected with hepatitis C;
• people who use drugs by injection;
• HIV-infected persons;
• people suffering from liver pathologies of unknown origin;
• persons regularly receiving hemodialysis;
• children born to infected women;
• people who have promiscuous sex without using condoms.

Symptoms

It should be noted that most people infected with the hepatitis C virus do not experience any symptoms for a long time. Despite the fact that the disease is latent, a mechanism of irreversible processes is triggered in the body, which ultimately can lead to the destruction of liver tissue - cirrhosis and cancer. This is the insidiousness of this disease.

In about 20% of infected people, symptoms of pathology still appear. They complain of general weakness, drowsiness, decreased performance, lack of appetite and constant nausea. Most people with this diagnosis lose weight. But most often there is discomfort in the right hypochondrium - exactly where the liver is located. In rare cases, pathology can be judged by joint pain and rashes on the skin.

Diagnostics

In order to make a diagnosis, the probable carrier of the virus must undergo the following diagnostic tests:

• determination of antibodies to the virus in the blood;
• determination of AST and ALT, bilirubin in the blood;
• PCR - analysis to determine the RNA of the virus;
• ultrasound examination of the liver;
• biopsy of liver tissue.

If the studies have shown a positive result for the presence of hepatitis C in the body, this may indicate the following facts:

1. A person is sick with a chronic form of the disease. He should do a biopsy of liver tissue in the near future to determine the extent of its lesion. You also need to do a test to identify the genotype of the virus strain. This is necessary to prescribe the appropriate treatment.
2. The person has had an infection in the past. This means that the virus previously entered the body of this person, but his immune system was able to cope with the infection on its own. There is no data on why the body of specific people was able to overcome the hepatitis C virus, while others continue to get sick. It is generally accepted that a lot depends on the state of the immune defense and the type of virus.
3. The result is false positive. Sometimes it happens that during the initial diagnosis, the result may turn out to be erroneous, but upon repeated analysis this fact is not confirmed. The analysis needs to be repeated.

Features of the course of infection in pregnant women

Usually, the course of hepatitis C has no relationship with the gestation process, complications are rare. A woman suffering from this disease throughout the entire gestational period requires more careful monitoring, since she has an increased risk of spontaneous abortion and the likelihood of developing fetal hypoxia compared to healthy women.

The observation of a patient with this disease should be dealt with not only by a gynecologist, but also by an infectious disease specialist. The probability of fetal infection during pregnancy and childbirth is no more than 5%. At the same time, it is impossible to prevent infection of the baby by 100%. Even if a woman, as a carrier of hepatitis C, undergoes an operative delivery - a cesarean section, this is not an infection prevention.

Therefore, after birth, the child is tested to determine the virus in the blood. In the first 18 months of a baby's life, antibodies to hepatitis C obtained during pregnancy can be found in the blood, but this cannot be a sign of infection.

If the diagnosis in the baby is nevertheless confirmed, it is necessary to observe it more carefully with a pediatrician and infectious disease specialist. children born to infected mothers are allowed in any case, since the virus is not transmitted through milk.

Treatment methods for pregnant women

There is no vaccine for the hepatitis C virus today. But it can be treatable. The main thing is to notice the infection in time: the chances of recovery will be higher if the infection was noticed at the very beginning.

Treatment for hepatitis C should be comprehensive. The basis of therapy is made up of drugs with a powerful antiviral effect. Ribavirin and Interferon are most often used for this purpose. But, according to additional research, these drugs negatively affect the developing fetus. Therefore, treatment of hepatitis C during pregnancy is undesirable.

There are times when specialists are forced to prescribe specific therapy to a woman. This usually happens when the expectant mother has vivid symptoms of cholestasis. In this situation, her condition deteriorates sharply, and something needs to be done urgently. This happens infrequently - in one woman in 20.

If there is a need to treat hepatitis C during pregnancy, doctors give preference to precisely those medications that are relatively safe for the expectant mother and her baby. Usually this is a course of injections based on ursodeoxycholic acid.

How is an infected woman giving birth?

In obstetrics, statistics have long been conducted on which method of delivery increases the risk of infection of a newborn or, conversely, decreases. But unambiguous statistics have not yet been obtained, since the likelihood of infection during childbirth is approximately the same both in the case of a cesarean section and in the natural process.

If the woman has hepatitis C, the delivery will be performed by caesarean section with poor liver function tests. Usually this happens in one expectant mother out of 15. In other cases, doctors choose the method of delivery, starting from the patient's state of health.

Infection of a child during childbirth can occur only from the mother's blood at the moment when the baby passes through the birth canal. If the medical staff is aware of the mother's illness, then the infection of the child is almost impossible - no more than 4% of cases. The experience and professionalism of doctors will help to exclude as much as possible the contact of the baby with the mother's blood secretions, in some cases an emergency caesarean section is performed.

Prevention of hepatitis C

During pregnancy planning, every woman should be tested for the presence of hepatitis C virus in the blood. Since infection usually occurs through contact with the blood secretions of a sick person, you should try to avoid any interactions with this physiological environment.

Hepatitis C during pregnancy is dangerous with a high risk of intrauterine infection of the fetus. Infection can also occur when the child passes through the birth canal. The urgency of the problem of hepatitis is constantly increasing, because the number of infected is increasing annually. The disease in a pregnant woman is more severe.

Stages of hepatitis C

Lasts 7-8 weeks, in some cases it increases to six months. Viral infection occurs in 3 stages:

• sharp;
• hidden;
• reactive.

Jaundice occurs in one in five patients. Antibodies in the blood can be detected several months after the virus enters the body. The outcome of the disease has two options: an acute infection ends with recovery or becomes chronic. The patient may not even be aware of the presence of hepatitis C.

The reactivation phase lasts 10–20 years, after which it turns into cirrhosis or liver cancer. A special analysis helps to identify the disease. If antibodies are found during the study, then hepatitis is suspected. This means that the person has been infected. Next, a blood test is performed for RNA of the infectious agent. If it is detected, it is necessary to determine the viral load and the type of hepatitis.

A biochemical blood test helps to choose the most effective therapeutic regimen.

The course of the disease

If antibodies to hepatitis C are detected in the woman's blood during the period of gestation, they look at how common it is. If more than 2 million replicas are found, the probability that the fetus will also become infected approaches 30%. With a low viral load, the risk of infection will be minimal. rarely gives complications during pregnancy. The baby becomes infected during childbirth, especially with the development of bleeding in the mother.

A child is born healthy if antibodies were found in the woman's blood, but the RNA of the virus was not detected. Antibodies in a child's body are present on average up to two years of age. Therefore, the analysis for hepatitis C up to this point turns out to be uninformative. If both antibodies and RNA of the infectious agent were found in a woman, the baby should be carefully examined. Doctors recommend diagnosing at 2 years of age. When planning a pregnancy and, a woman must be tested for HIV and hepatitis C. After antiviral therapy, you will have to wait at least six months.

Treatment of pregnant women

If a virus is detected in a woman's body, she needs to be examined. First of all, attention is paid to the presence of symptoms of liver damage. A detailed examination is carried out after the birth of the child. the virus should be informed about the possibility of transmission of the infection in the household. You must have personal hygiene items:

Antiviral therapy can only be started with the permission of a doctor. The risk of developing hepatitis C increases with HIV infection.

Since the disease negatively affects pregnancy, regular viral load testing is necessary. A similar analysis is carried out in the 1st and 3rd trimester. It helps to assess the likelihood of infection in an unborn child. Some diagnostic methods cannot be used due to the high risk of intrauterine infection. The duration of the therapeutic course during pregnancy is 6–12 months. In the recent past, drugs from the group of linear interferons were used, which have low efficiency:

Labor management in patients with hepatitis

The optimal delivery method for infected women is controversial. Some experts believe that dangerous consequences for the child do not occur during a cesarean section. According to statistics, the operation reduces the risk of perinatal infection by up to 6%. Whereas in natural childbirth, it approaches 35%. In any case, a woman makes a decision on her own. The determination of the viral load is important. Professionals must take all measures to prevent infection of the child.

The theory regarding the possibility of infection of the newborn through breastfeeding has not received official confirmation. However, it should be remembered that other infections, such as HIV, can be transmitted through mother's milk. The child of a woman who has been diagnosed with hepatitis C should be under constant supervision. Tests are performed at the age of 1, 3, 6 and 12 months. If RNA of the virus is detected in the blood, the child will be considered infected. It is necessary to exclude chronic forms of hepatitis.

Why is hepatitis C dangerous for a pregnant woman? Even if the mother does not catch the infection, the infection weakens her body. It is advisable to complete treatment for hepatitis C before delivery. The danger of chronic hepatitis lies in the occurrence of severe complications. In addition, the disease disrupts the functions of the liver, and this organ is involved in the metabolism between the organisms of the mother and the child. The most common complications are:

• cholestasis;
• late toxicosis (gestosis);
• fetal hypoxia;
• spontaneous abortion.

It is now very widespread and is especially difficult in comparison with other types of hepatitis.

In obstetrics and pediatrics, this problem becomes even more significant. This is due to the high risk of intrauterine infection of the child and the possibility of infection of the newborn.

Pregnant women often do not even know that they are carriers of hepatitis C. This becomes a complete surprise for them when taking tests at the antenatal clinic.

With this disease, you can give birth to a child, but chronic hepatitis can negatively affect the fetus and the mother's body. One of the dire consequences of this disease is the complete destruction of the liver.

In some cases, a woman who tests positive for hepatitis C does not carry the virus. This occurs when donating venous blood in different laboratories and using various diagnostic kits.

How can infection occur?

The development of hepatitis C is associated with an RNA virus from the flavivirus family. It is transmitted during frequent sexual contact with different partners and through blood.

An equally common route of infection is from an infected mother to a child. New infections of this type of hepatitis are constantly observed in drug addicts due to non-sterile syringes. Also, the cause of the development of the hepatitis C virus can be a hereditary factor.

The clinical picture of the development of hepatitis C in pregnant women

With this disease, there may be no symptoms at all. Sometimes they are mild. But if untreated, the disease can drag on and end with liver cancer. The incubation period is from 2 weeks to 27 weeks... This disease occurs in pregnant women in three stages: acute, latent and reactivation.

Primary hepatitis C infection is characterized by the following symptoms:

• feeling unwell;
• weakness;
• jaundice, which confirms liver problems.

Most often, the acute phase of the disease is not detected, since the symptoms are mild. Hepatitis C in acute form may result in recovery or be replaced by a latent phase, in the presence of which infected persons consider themselves to be absolutely healthy.

Often, an acute infection becomes chronic. In this case, there is a risk of developing liver cirrhosis and the appearance of hepatocellular carcinoma. The chronic form is characterized by the following symptoms:

• fatigue;
• persistent nausea;
• depression;
• poor concentration of attention;
• muscle pain;
• memory impairment;
• pain in the liver.

Disease detection

Danger to the fetus and newborn baby

When detecting hepatitis C virus RNA in a pregnant woman, doctors pay attention to the degree of its prevalence. The likelihood of intrauterine infection will be much greater if detected more than two million copies of the virus.

If there is a virus in a woman's body in the amount of one million or less, the likelihood of infection of the fetus will be small. In the case of chronic viral hepatitis C in pregnant women, complications are usually not observed.

The fetus can become infected during childbirth if the blood of an infected mother gets on the wounds on the baby's body. With a planned caesarean section, the risk of infection is lower compared to vaginal delivery.

The virus is not transmitted through breast milk, but if the nipples are damaged and there are injuries in the baby's mouth, infection becomes quite possible. The likelihood of infection increases if a woman has HIV.

Which doctors should I contact?

When diagnosing hepatitis C, you need to contact a hepatologist and undergo a thorough examination. Pregnant women with acute hepatitis C are sent to special infectious diseases wards, where they will subsequently give birth. With non-viral forms of hepatitis, women in labor are placed in ordinary maternity hospitals. In this case, childbirth can be natural in the absence of contraindications. If they are available, a caesarean section is prescribed.

Preventive measures

It is advisable for a pregnant woman with hepatitis C to stop drinking alcohol and lead a healthy lifestyle. The organization of proper nutrition is of great importance. You need to eat in small portions and preferably several times a day. The diet should contain the necessary minerals and vitamins.

Car exhaust, varnishes, paints and combustion products will be harmful to pregnant women with hepatitis C. Women with this disease should not be overcooled and overworked, so heavy physical activity should also be excluded.

A vaccine against hepatitis C has not yet been developed.