https://padlet.com/r_henderson2/rorvyko693cm en-us 2017-10-05 16:52:39 UTC 2017-10-06 09:31:01 UTC hello@padlet.com https://padlet.com/r_henderson2/rorvyko693cm/wish/194586915 Infectious disease of the liver cause by the hepatitis B virus and can be classified as acute or chronic (NICE, 2014). It is a DNA virus with an incubation period of 2-6 months but detectable in circulation from 1 month post infection (Doumouchtsis and Arulkumaran, 2016).]]> 2017-10-06 08:21:19 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194586915 https://padlet.com/r_henderson2/rorvyko693cm/wish/194589428 Transmitted through blood and blood products, IV drug abuse and sexual activity. Vertical transmission (transmission from mother to baby during pregnancy and/or childbirth) (Doumouchtsis and Arulkumaran, 2016). Hep b prevalence is highest in the WHO Western Pacific region and the WHO African region where 6.2% and 6.1% respectively of the adult population is infected. The European region has a 1.6% prevelance across the population (WHO, 2017).

]]> 2017-10-06 08:29:46 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194589428 https://padlet.com/r_henderson2/rorvyko693cm/wish/194592329 If you become infected with the hep B virus before the age of 6, you are more likely to develop chronic infection. 80-90% of infants infected during the first year of life develop chronic infections (WHO, 2017).]]> 2017-10-06 08:40:52 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194592329 https://padlet.com/r_henderson2/rorvyko693cm/wish/194592705 2/3 of acute hep B sufferers are asymptomatic, sub clinical or associated with flu-like symptoms. Adults who are chronically infected may go on to develop cirrhosis of the liver and/or liver cancer (WHO,2017) (Doumouchtsis and Arulkumaran, 2016)]]> 2017-10-06 08:42:15 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194592705 https://padlet.com/r_henderson2/rorvyko693cm/wish/194593192 Most people do not experience any symptoms during the acute infection phase. 
- GI Symptoms e.g. Nausea, vomiting, anorexia, right hypochondrial discomfort
- Jaundice (although not evident in half of cases)
- Dark urine
- Extreme fatigue
(WHO,2017) (Doumouchtsis and Arulkumaran, 2016)]]> 2017-10-06 08:44:21 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194593192 https://padlet.com/r_henderson2/rorvyko693cm/wish/194595876 Midwives should ensure that all pregnant women are provided with information about hep B, including routes of transmission and implications for infant and maternal health. We should offer AN testing early in pregnancy and give women time and support necessary to reach her own informed decision. Women diagnoses as infected with hep B should be referred for discussion on the implications for themselves, their pregnancies and their sexual partners. Midwives should also discuss the risks and benefits of the hep B vaccines for babies of hep B positive women (RCM, 1999). ]]> 2017-10-06 08:54:13 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194595876 https://padlet.com/r_henderson2/rorvyko693cm/wish/194596067 Antenatal detection should be followed with a preventative programme - this involves the newborn receiving hep B immune globulin IM within 12 hours of birth along with the first of 3 doses of recombinant vaccine in the other thigh. The second and third doses should be administered at 1 and 6 months and immunity confirmed at 1 year. This can reduce the vertical transmission risk of 10-90% to the region if 0-3%. In pregnancy we should monitor hydration, uterine activity and LFT's (Doumouchtsis and Arulkumaran, 2016).
There is no specific treatment for acute hep B so care is aimed at maintaining comfort and adequate nutritional balance. Chronic hep B can be treated with medicines, including oral antiviral agents (WHO, 2017).
No antiviral agent has been approved by the US Food and Drugs Administration for use in pregnancy. However the effects should be considered to mother and fetus as stopping or changing medication will adversely effect short and long term liver disease outcomes. On the other hand, in terms of the fetus, the concern is risk of exposure to medication during early embryogenesis (Bzowej, 2010).]]> 2017-10-06 08:54:56 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194596067 https://padlet.com/r_henderson2/rorvyko693cm/wish/194596213 All women are offered hep B screening so that postnatal interventions can be offered to infected women to decrease the risk of mother-to-child transmission. Screening is offered at the booking appointment which should ideally be conducted by 10 weeks (NICE, 2008).
There are 2 antigens:
HBeAg - antigen found from the core of the virus and indicates high infectivity and high risk of the vertical transmission (90%)
HBeAg - antibody to the core antigen and indicates partial immunological response and low risk of transmission (10%) (Doumouchtsis and Arulkumaran, 2016)]]> 2017-10-06 08:55:25 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194596213 https://padlet.com/r_henderson2/rorvyko693cm/wish/194596280 WHO (2017) - Hepatitis B
Doumouchtsis and Arulkumaran (2016) - Emergencies in Obstetrics and Gynaecology
RCM (1999) - Position Statement 
Bzowej (2010) - Hepatitis B Therapy in Pregnancy
NICE (2008) - Antenatal Care]]> 2017-10-06 08:55:38 UTC https://padlet.com/r_henderson2/rorvyko693cm/wish/194596280