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Re: Hep C and pregnancy (Long)From: rmodugno@aol.comMon May 25 15:55:43 2009
Remember, the MFM sees a "concentrated" population of Hep c patients. This is from Up-To-Date: WHO SHOULD BE TESTED — Several organizations have provided guidelines for who should be tested. Despite having reviewed similar data and including experts, the various guidelines do not all agree. The following summarizes recommendations from the major organizations. United States Preventive Services Task Force — The United States Preventive Services Task Force (USPSTF) recommends against routine screening for hepatitis C infection in asymptomatic adults who are not at increased risk for infection [1]. In addition, they found insufficient evidence for or against routine screening for HCV infection in adults at high risk for infection. In making this recommendation the USPSTF notes potential harms of screening and treatment including labeling of the patient, adverse treatment effects, and unnecessary liver biopsies. This recommendation should be interpreted as suggesting the need for additional research [2]. A response from the Centers for Disease Control and Prevention to the USPSTF recommendation emphasizes that medical and public health professionals should continue the practice of screening persons for risk factors, offering testing to those at increased risk [3]. Centers for Disease Control and Prevention — The Centers for Disease Control and Prevention recommend that testing for HCV should be routine in patients at incre ased risk for infection, including those who (http://www.cdc.gov/mmwr/pdf/rr/rr5203.pdf): Ever injected illegal drugs Received clotting factors made before 1987 Received blood/organs before July 1992 Were ever on chronic hemodialysis Have evidence of liver disease Testing should also be performed based upon the need for exposure management including: Healthcare, emergency, and public safety workers after needle stick/mucosal exposure to HCV-positive blood Children born to HCV-positive women Routine testing is not recommended (unless an additional risk factor is identified) in: Healthcare, emergency medical, and public safety workers Pregnant women Household (non-sexual) contacts of HCV-positive persons The general population The need for testing is uncertain in the following groups: Recipients of transplanted tissue Intranasal cocaine or other non-injecting illegal drug users Those with a history of tattooing, body piercing Those with a history of sexually transmitted diseases or multiple sex partners Long-term steady sex partners of HCV-positive persons National Institutes of Health — The National Institutes of Health (NIH) consensus guidelines are similar to those of the CDC above with the exception of recommending screening in those who received a blood transfusion or organ transplantation prior to 1990 (rather than 1992). In addition, the NIH panel recommended screening individuals with multiple sexual partners, spouses or household contacts of HCV-infected patients, and those who s hare instruments for intranasal cocaine use. (http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm). American Association for the Study of Liver Diseases — A practice guideline issued by the American Association for the Study of Liver Diseases (AASLD) recommends testing for the following groups [4]: Those who have injected illicit drugs in the recent and remote past, including those who injected only once. Those with conditions associated with a high prevalence of HCV including HIV infection, hemophilia who received clotting factor concentrates before 1987, persons who were ever on hemodialysis, and those with unexplained abnormal aminotransferase levels. Prior recipients of transfusions or organ transplants, including those who were notified that they had received blood from a donor who later tested positive for HCV, and persons who received a transfusion or organ transplantation before 1992. Children born to HCV-infected mothers. Healthcare, emergency and public safety workers after a needle stick injury or mucosal exposure to HCV-positive blood. Current sexual partners of HCV-infected persons. Author's recommendations — Our general approach is consistent with the guidelines recommended by the AASLD. Notably, the presence of an abnormal serum ALT level, any history of injection drug use, and a history of blood transfusion before 1992 identified 85 percent of HCV RNA positive participants between ages 20 to 59 in the most recent National Health and Nutrition Examina tion Survey in the United States [5]. ************************************************************ It would seem to me that routine testing for Hep c is not indicated. Gee,= we might have to take a history to get some risk factors! ;+) Robert Modugno MD MBA FACOG Sylva, NC -----Original Message----- From: Dr Elrod <dr99645@yahoo.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> Sent: Mon, 25 May 2009 3:10 pm Subject: Re: Hep C and pregnancy That may be. We have our fair share. Sent from my iPhone On May 25, 2009, at 7:39 AM, eramirezt@coqui.net (Efrain Ramirez) wrote: Too many patients with tatoo and piercing Ef At Sat, 23 May 2009, Glen Elrod wrote: Our local perinatologist has suggested that due to the high numbers of Hep C that they see, that we add Hep C Ab testing to our routine prenantal set. I am not familiar with hep C testing beyond simple antibody testing. If a pregnant woman is positive for Hep C AB what is the next testing needed? >From what I've read, I'm assuming it will be LFT and a test for viral load. Thanks, Glen -- "Life is what happens to you while you're busy making other plans."- John Lennon
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