Re: Hep C and pregnancy (Long)
From: Efrain Ramirez (eramirezt@coqui.net)
Mon May 25 17:11:33 2009
2 patients from 3 = tattooing.
Ef
At Mon, 25 May 2009, rmodugno@aol.com wrote:
>
>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
--
"Life is what happens to you while you're busy making other plans."- John Lennon
