Table 3.
Diagnosis, Treatment and Prevention of Other Types of Viral Hepatitis in Pregnancy
| Type of Viral Hepatitis | Diagnosis | Maternal Treatment/Prevention | Mode of Delivery | Breastfeeding |
|---|---|---|---|---|
| Herpes Simplex (DNA virus)104 | Serum testing for HSV IgG and DNA PCR in a symptomatic patient with compatible symptoms. Liver biopsy can be considered for histology and PCR testing. |
No vaccine is available but is under investigation. Treatment with IV acyclovir |
Cesarean delivery is recommended in women with active genital lesions or prodromal symptoms, e.g., vulvar pain or burning Cesarean delivery may be offered for women with primary or non-primary first episode in the third trimester due to the possibility of prolonged viral shedding |
Yes, provided no active herpetic lesions on the breast |
| Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical CMV transmission is NOT RECOMMENDED | ||||
| Cytomegalovirus (DNA virus)105 | Test if symptomatic or confirmed exposure. Serum quantitative CMV DNA PCR testing. Serial maternal testing for CMV IgM and IgG (with avidity assay) at baseline and in 3–4 weeks |
No maternal vaccination available. Supportive care. SMFM does not recommend antenatal treatment with ganciclovir or valacyclovir. Antenatal antiviral ganciclovir therapy should only be offered as part of a research protocol. |
Yes, provided appropriate hygienic precautions taken Neonates born at GA <30 weeks or with birthweight <1500g may be at increased risk of late onset sepsis-like syndrome and long term impact on hearing and growth; patients should be counseled on the risks vs benefits of breastfeeding.106–108 |
|
| Varicella Zoster (DNA virus)105 | Clinical diagnosis in the setting of typical vesicular rash. VZV may also be diagnosed by qualitative viral PCR assay of infected fluids (vesicular fluid, amniotic fluid) |
VZV vaccination at age >12 months is recommended to prevent disease in adulthood. VZV vaccination is contraindicated in pregnancy as it is a live, attenuated vaccine. Oral acyclovir initiated within 24 hours of maternal symptom onset is recommended. IV acyclovir may be used in patients with systemic infection. Women who are not immune to VZV and are exposed to someone with primary VZV should receive VZIG within 96 hours. (Up to 10 days permitted). |
Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical VZV transmission is NOT RECOMMENDED |
Yes, provided no active lesions on the breast |