Hepatitis C virus (HCV) Hepatitis delta virus (HDV) Hepatitis E (HEV) Herpes simplex hepatitis (HSV)

Department of Obstetrics and Gynaecology

Hepatitis C virus (HCV)
HCV previous called non-A, non-B hepatitis. Prevalence in Denmark 0,1 - 0,5 %.
Incubation period 6-8 (2-12) weeks

Transmission:
Parenteral, blood, IV drug users, less than 10%sexual transmitted. Risk after needle injury 3-10 %. The infection is often asymptomatic.

Milk uncommon, there appear to be only a low risk of infection with sexual contacts (< 5% of long term sexual partners get infected) or IV drug use.

Most often post-transfusion hepatitis but in many cases obscure 60-80% get chronic infection and of these 20% develop cirrhosis after 10-30 years, and 1-3% cancer.

Mother to child transmission rate is about 5-7% for HIV negative mothers and occur predominantly or exclusively in the prenatal period. The risk for HIV pos mothers 15%. Theoretical risk for amniocentesis. Scalp electrodes should be avoided.

Diagnosis:
Chronic Anti HCV and HCV-RNA positive. Antibodies are not protective. Re-infection possible.

Treatment of chronic stage:
Not recommended in pregnancy.

There is no vaccine to prevent HCV.
Seems to be seen more often in case of intrahepatic cholestasis of pregnancy.

Hepatitis D virus
Hepatitis delta virus (HDV) (co-infection with Hepatitis B). Transmission: Parenteral. Incubations period 3-12 weeks, Very rare in Denmark.
The risk for fulminant hepatitis is increased if the hepatitis B infection arise the same time as the hepatitis D infection
Is only found in HBsAg-positive people, most of whom are HBeAG-negative. Prevention of HBV infection or transmission will also prevent HDV. No risk for the fetus??

Hepatitis E (HEV)
Transmission: Fecal-oral, often epidemic in association with contaminated water. Increase the risk for severe Hepatitis B infection. Incubation period 2-9 weeks. Very rare in Denmark. Symptoms similar to hepatitis A in non-pregnant. The risk for fulminant hepatitis in pregnant woman is 15% with a mortality of 20% (hepatic encephalopathy and hepatic failure). Highest risk in III trimester. No cronic disease.

Hepatitis GBV-C
Transmission: Parenteralt does not seems to be clinical significant

Herpes simplex hepatitis (HSV)is very rare
May cause fulminant hepatitis with an associated high mortality. Clinical signs: Fever, abdominal pain, and jaundice is unusual but transaminases elevated leucopenia and prothrombin time prolonged.

Diagnosis:
Viral culture of the liver and detection of IgG and IgM HSV antibodies may be helpful.

Therapy:
Acyclovir can also prevent/decrease transmission to the infant.

Mother to Child
Crude transmission rates have varied from 0 to 100%.

References:
(1) Nielson-Piercy, C. Handbook of Obstetric Medicine. 2001 Edition.

(2) Infpreg.com

(3) www.uptodate.com 2007