Launceston General Hospital Clinical Guideline

P2010/0315-001

WACSClinProc1.208WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Hepatitis C and Pregnancy Hepatitis C Policy LGH Protocol 1.2-02 WACS Hepatitis C and pregnancy Midwives and medical officers, QVMU Hepatitis C, pregnancy, birth, breastfeeding P2010/0314-001 Antenatal Care P2010/0518-001 Infection Control & Infection Control Procedures

Hepatitis C Hepatitis C is a single-stranded RNA virus. Hepatitis C is transmitted through infected blood exposure or mother to infant (vertical) transmission. Incubation time for acute HCV infection is usually 30 to 60 days. HCV RNA can be detected in blood within 2 weeks of exposure. Most (75%) of HCV infections are asymptomatic. Symptomatic patients present with malaise, fever, abdominal pains and jaundice. These symptoms are generally milder than those seen with hepatitis B viral infection. Prospective studies have shown that 60 to 80% of HCV infected persons develop chronic infection. Factors associated with spontaneous clearance of HCV infection include younger age, female gender and certain major histocompatibility complex genes. Vertical Transmission The maternal viral titre appears to be an important determinant of vertical HCV transmission. Hepatitis C is only transmitted to the baby if the mother is positive to hepatitis C RNA at the time of birth. The higher the concentration of serum HCV RNA, the more likely the chance of vertical transmission. Hepatitis C antibody positive mothers who are RNA negative pose no risk to the baby at the time of birth although the baby will have maternal hepatitis C antibodies circulating for up to 14 months following birth even if the mother was RNA negative. The risk of transmission from a hep C RNA positive mother to a baby is approximately 6 8 %. Infants born to HCV positive mothers will have passively acquired antibodies. In uninfected infants loss of maternal antibodies will be seen within 18 months. Antibody testing of infants should be carried after the child reaches 18 months of age. Antenatal Screening Hepatitis C screening should be offered to all pregnant women. Risk factors for HCV which should be considered during antenatal history taking include: injecting drug use, migration from a country with a high rate of endemic HCV (Southern European, African and Asia/Pacific countries), history of transfusion of blood products prior to 1990, and history of incarceration. All pregnant women should be provided appropriate pre-testing counselling before Hepatitis C screening. Pregnant women who test positive for anti-HCV
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antibodies should be offered qualitative HCV RNA testing to determine if they are still infectious. Treatment during Pregnancy There is currently no safe treatment for HVC infection during pregnancy. Birth The rate of vertical transmission is similar for vaginal and caesarean birth. Invasive fetal procedures such as the application of a fetal scalp electrode or fetal blood sampling should be avoided. Standard precautions are recommended with routine cleaning of instruments, equipment and the environment. Breastfeeding Breastfeeding is not contraindicated in women with hepatitis C. If a woman develops cracked or bleeding nipples she should express and discard the breastmilk until the nipples heal. Resources for Women RPAH 2005 Hepatitis C and pregnancy: Getting tested during pregnancy http://www.hepatitisc.org.au/resources/inforesources.html Hepatitis C Council of NSW 2007 Hep C factsheet: Pregnancy, babies & children http://www.hepatitisc.org.au/quickref/factsheet.html Hep C Helpline: 1 800 803 990 Hep C Internet Information: www.hepatitisc.org.au Peer support: www.hepcaustralasia.org Liver Clinic is held in LGH Specialist Clinics on Mondays and provides treatment for Hepatitis C. Medical referral is required.

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Attachments Attachment 1

References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years. Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: October 2008

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APPENDIX 1 REFERENCES Airoldi, J & Berhella, V 2006 Hepatitis C and Pregnancy, Obstetrical & Gynecology, vol. 61, no. 10, pp. 666-672. Batey, R & Jones, T 2005 Hepatitis C, pregnancy and child raising, The Hep C Review, Online: www.hepatitisc.org.au/resources/documents/48_1.pdf Australian Government Department of Health & Ageing, National Hepatitis C Testing Policy 2007 Online: http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-hepc-testing-policymay07 RCOG College Statement 2006 Antenatal Screening Tests Online: http://www.ranzcog.edu.au/publications/collegestatements.shtml#CObs Three Centre Consensus Guidelines on Antenatal Care 2006 Online: http://www.3centres.com.au/guide_frame.htm

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