Hepatitis B Complicating Pregnancy and Its Fetomaternal Outcome

BACKGROUND: Today, the hepatitis B virus (HBV) is a global health issue. In 2009, the World Health Organization estimated that more than 2 billion people have been infected with HBV at some point in their lives, with 350 million people worldwide being chronic carriers of the virus. A million people are predicted to die each year. Viral hepatitis in pregnancy is a contentious issue around the world. Both foetal and maternal outcomes can range from minimal issues to the greatest morbidity and even fatality AIM AND OBJECTIVE: To determine the maternal and fetal outcome of Hepatitis B complicating pregnancy. MATERIAL AND METHODS: A Prospective analytical observational study of Hepatitis B complicating pregnancy was carried out at Government Mohan Kumaramangalam Medical College and Hospital, Salem during the period of January 2020 to January 2021. HbsAg positive patients admitted to Antenatal ward and Labour ward of Obstetrics & Gynecology Department were observed and 50 term cases were recruited in the study to observe the fetomaternal outcome. A structured proforma was used to collect information regarding gestational age, regular antenatal visits and associated disorders were obtained from history. Routine and HbsAg investigations were done. Complications during antenatal period, delivery and postpartum were observed. Details regarding mode of delivery, gestational age, timing of LSCS and birth weight of the baby were noted. Babies admitted in NICU and the mothers followed up till they were discharged. RESULTS: The incidence of Hepatitis B complicating pregnancy during the study period at GMKMCH, Salem was 0.4 %. About 20% were in < 20 years of age, 46% patients were in the age group of 21 to 25 years of age and remaining 34% were in the age group of 26 to 30 years of age. Around 52% were Primi, 12% were G2A1, 14% were G2P1L1, 6% were G3A2, 12% were G3P1L1A1 and 4% were G3P2L1. All the patients were booked and immunized. 94% were came to our hospital by the referral from Primary health centre and only 6% of the HBV Pregnant Mothers came as self to our hospital for the safe confinement. About 34% of patients had associated with comorbiditis like GDM, GHT, anemia, seizure disorder and hypothyroid. • In the study group, mean pulse rate was 79.6 + 6.5. The mean Systolic blood pressure was 112.6+ 9.8. The mean Diastolic blood pressure was 68.6 + 8.8. The hemoglobin levels in HBV pregnant mothers were explained based on the WHO classification. None in Severe anemia. About 6% had pallor and 16% had bilateral pedal edema. Out of 50 HBV pregnant mothers 16% had elevated liver function test, 8% had hepatomegaly, 6% had splenomegaly and only one mother had abnormal portal vein doppler. Regarding the mode of delivery, about 34% had Lower segment Caesarean section and 66% had Labour Natural. About fetal outcome 90% were term baby and 10% were Preterm baby. 10% were low birth weight babies weight less than 2.5kgs and 10% of new born required NICU admission. CONCLUSION: Breastfeeding is not contraindicated in women with HBV infection with appropriate hygienic precautions, if the infant receives HBIG passive prophylaxis and vaccine active prophylaxis. Susceptible pregnant women who are at risk for hepatitis B infections should be specifically targeted for vaccination. All patients tested positive for hepatitis B surface antigen should also be screened for HBeAg to know the viral load and disease severity, which will help for better management and reduce maternal mortality and perinatal transmission