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High Risk Pregnancy
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Is Pregnancy Possible After Endometrial Ablation?
As per statistics, the chances of getting pregnant after undergoing an endometrial ablation is less than 1%. If you want to get pregnant later, you should not consider endometrial ablation, as this procedure would make it harder for you to conceive. Women who undergo endometrial ablation are suggested to use birth control precautions after menopause. You may also consider ‘sterilisation’ as a further treatment for prevention of pregnancy after an ablation procedure.
Endometrial Ablation – What Is It and Why It Is Done?
The procedure of destroying a very thin layer of the uterus lining (endometrium) is known as endometrial ablation. Women experiencing heavy bleeding during their menstrual cycles are suggested to undergo an endometrial ablation in case oral medications don’t give relief or the cause of heavy bleeding is unknown. Endometrial ablation uses heat, cold or different types of energy to destroy the lining of the uterus, and the procedure is less dangerous and has fewer obstacles compared to a hysterectomy.
Most importantly, it is done on women who don’t plan to have children in the future.
What Are the Chances of Pregnancy Post Endometrial Ablation
Pregnancy is not likely after undergoing an endometrial ablation, but it can still happen with a high risk of complications during pregnancy. Many women have reportedly had a successful pregnancy after endometrial ablation, but they also come with a lot of risks associated with them. If you become pregnant after getting this procedure done, you are at high risk of suffering a miscarriage. Women who prefer to get pregnant later should never undergo this ablation procedure.
Another doubt many women tend to have is – ‘Can you get pregnant after an ablation and tubal litigation?’ Well yes, you can get pregnant after tubal litigation, as it is not a 100% guarantee of contraception. In this case, the chances are that you might suffer an ectopic pregnancy in which the eggs get attached to the fallopian tubes instead of the uterus.
Effects of Endometrial Ablation Procedure on Pregnancy
Endometrial ablation removes most of the endometrial tissue from the uterus. The lining left after the procedure is inadequate for the implantation of the foetus and its consequent nourishment needs. Due to this reason, a woman cannot conceive after she undergoes endometrial ablation.
Many studies reported ectopic pregnancy, termination, or miscarriage. Pregnancies that continued experienced high instances of preterm delivery, morbidly adherent placenta, spontaneous abortion, caesarean delivery, and caesarean hysterectomy. The reports also mentioned premature rupture of membranes, intrauterine growth restriction, intrauterine fetal demise, uterine rupture, and neonatal demise. However, in one 2017 study, the case reported successful pregnancy after microwave endometrial ablation.
Pregnancy Risks and Complications After Endometrial Ablation
Every procedure comes with a certain amount of risk associated with it. Women who undergo endometrial ablation should know the following risks and complications they might face during and after the procedure:
1. Risk of Perforations
The tool that the doctor uses for your ablation could puncture your uterus or harm nearby organs.
2. Foul Smelling Discharge
If you notice any bad odour from your vaginal discharge, you should immediately consult a doctor.
3. Fever
Some of the women who undergo endometrial ablation experience fever after the procedure.
4. Chills
Few women have also reported having chills after their ablation procedure.
5. Infection
This is a very common risk that is associated with an endometrial ablation procedure.
6. Heavy Bleeding
You may experience heavy to intense bleeding after this procedure. If you are not feeling well or experience giddiness, please reach out to your physician immediately.
7. Intense Cramping
Sometimes after undergoing an endometrial ablation procedure, some women have complained of excruciating stomach pains or cramping of the lower abdomen.
8. Continual Bleeding
A small percentage of women experience continuous bleeding lasting more than two days after the procedure.
9. Nausea
Some women have experienced nausea in the first few hours of the endometrial ablation procedure.
10. Trouble Passing Urine
There can be an urge to pee for the first 24 hours of the procedure.
11. Risk of Burns
There are various methods to perform endometrial ablation. In some of the procedures, there are chances of burn injuries to the vaginal areas and bowel.
12. Fluid Absorption in the Body
The fluid that is used in the expansion of your uterus during the process of electrosurgery might result in getting absorbed into your bloodstream. Though this happens in the rarest of rare cases, this can be a very dire condition. To prevent this from happening, the fluid used is carefully monitored throughout the procedure.
Things to Consider If You Get Pregnant After Endometrial Ablation
Although pregnancy after undergoing endometrial ablation is very rare, it does happen sometimes. These pregnancies have a certain amount of risk associated with them. That is the reason women undergoing endometrial ablation are advised to use reliable contraception after the procedure, and any unlikely pregnancy may have serious complications. If you are pregnant after undergoing the endometrial ablation procedure, you should consult your doctor to evaluate placental adherence and your subsequent delivery. Below are some facts that would provide you with insights into what things you should consider if you get pregnant after the ablation procedure:
1. Premature Delivery
The baby’s birth may take place more than three weeks before the baby’s estimated due date, often resulting in complicated medical problems.
2. Uterine Rupture
The endometrial ablation procedure raises the risk of uterine rupture or preterm premature rupture of membranes in pregnant women who have previously undergone the ablation procedure. This may result in compromising maternal and foetal life.
3. Caesarean Delivery and Caesarean Hysterectomy
You may have to undergo two simultaneous operations – first, the caesarean delivery and then the caesarean hysterectomy. The caesarean hysterectomy procedure involves the removal of the uterus at the time of caesarean delivery.
4. Perinatal Mortality
Preterm birth is the most common cause of perinatal mortality, leading to almost 30% of neonatal deaths.
5. Morbidly Adherent Placentation
In the rarest of rare cases, some of the pregnancies may result in morbidly adherent placentation in which the placenta grows too deeply into the uterus walls and is unable to detach during childbirth.
The endometrial ablation procedure is used for treating women who experience heavy and prolonged bleeding time during their menstrual cycle. The menstrual cycle either disappears completely or becomes lighter with this procedure. Women who want to conceive later in their life should not consider this procedure as this makes pregnancy very difficult. To reduce the chances of pregnancy, it is advisable to undergo a sterilisation process after endometrial ablation, along with using the usual birth control measures.
References/Resources:
1. Endometrial Ablation; Cleveland Clinic; https://my.clevelandclinic.org/health/treatments/21734-endometrial-ablation
2. Endometrial Ablation; Johns Hopkins Medicine; https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation
3. Ibiebele. I, Nippita. T. A, et al.; A study of pregnancy after endometrial ablation using linked population data; AOGS, Wiley Online Library – Obstetrics & Gynaecology; https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14002; September 2020
4. Kohn. J. R, Shamshirsaz. A. A, Popek. E, et al.; Pregnancy after endometrial ablation: a systematic review; BJOG, Wiley Online Library – Obstetrics & Gynaecology; https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.14854; January 2018
5. Endometrial Ablation; The American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/faqs/endometrial-ablation; Last updated: January 2022
6. Alabi. C, Pickersgill. A; Successful pregnancy after microwave endometrial ablation: case report; Gynecological Surgery; Springer Open; https://gynecolsurg.springeropen.com/articles/10.1007/s10397-007-0343-0; September 2007
7. Bauer. A, Sheyn. D, et al.; 589: Incidence and outcomes of pregnancy after endometrial ablation in a multi-institutional cohort; AJOG; https://www.ajog.org/article/S0002-9378(16)31302-3/fulltext; January 2017
8. Foote. M, Rouse. A, Gil. K. M, et al.; Successful pregnancy following both endometrial ablation and uterine artery embolization; Fertility and Sterility, Volume 88, Issue 6, Pages 1676.e15-1676.e17; ScienceDirect; https://www.sciencedirect.com/science/article/pii/S0015028207002361; December 2007
9. Endometrial Ablation; Mayo Clinic; https://www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932
10. Xia. E, Li. C, et al.; The occurrence and outcome of 39 pregnancies after 1621 cases of transcervical resection of endometrium; Human Reproduction, Volume 21, Issue 12, Pages 3282–3286; Oxford Academic; https://academic.oup.com/humrep/article/21/12/3282/2939178; December 2006
11. Ansong. S, Glackin. K; Pregnancy after Endometrial Ablation : 3 cases; Queen’s University Belfast; https://www.qub.ac.uk/schools/mdbs/Study/ClinicalAcademicTraining/Filestore/Filetoupload,1000949,en.pdf
Also Read:
Pregnancy After a Vasectomy
Pregnancy with Small Uterus
Cervical Cancer in Pregnancy
Hepatitis B Infection during Pregnancy
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Small Uterus and Pregnancy
Most women don’t realise they have a small uterus until they get pregnant. When a woman suspects she is pregnant and goes to a doctor, a gynaecological exam or an ultrasound may bring this news (of having a small uterus) and can cause immense worry. At times, the doctor’s language may also instil fear. However, it is always essential to get to the bottom of it and understand the health condition properly. This article has put together some important aspects about having a small uterus and pregnancy. The points below cover all your woes regarding a small uterus vis-a-vis pregnancy.
What Causes Formation of Small Uterus?
As per medical science, the uterus size varies in all women. However, the size that has been termed as a specific benchmark is what has been observed in a majority of women. The neck length of the uterus is usually 25mm, with the myometrium as thick as 30mm or so. The actual dimensions of the uterus tend to be 40-50mm in width, whereas the length is usually 70-80mm. These parameters are generally used as a reference, but many women tend to have a completely healthy uterus that might not be as large as this.
In some women, the uterus can be larger than the average or even smaller. However, it should function just fine. A woman’s body physique is a major governing factor for uterus size. Therefore, preternaturally thin women with a small body face have higher chances of having a small uterus.
Is It Possible for a Woman to Conceive Successfully If She Has a Small Uterus?
The tiny foetus at conception grows into a full-fledged baby by the end of the pregnancy. Therefore, it is crucial to understand whether women can conceive successfully with a small uterus. Any chances of risk should be mitigated right from the start.
One of the critical factors to be considered to conceive in the presence of a small uterus successfully is the epithelium. Enhanced blood flow can help with its growth. Sometimes, a doctor may also recommend a pregnant woman undergo hormonal stimulation to increase the chances of conception.
Any hormone therapy affects the external genitalia. Hormone therapy may be suggested for women who suffer from a condition where the uterus, as well as the genitals, are underdeveloped, causing an imbalance of various hormone levels within the body. Termed as hypoplasia, it could also indicate the presence of other illnesses. Undertaking hormonal therapy in such a case could make matters worse.
At times, proper intake of vitamins and minerals could make conception possible. You can opt for vitamin therapy if you are pregnant and have a small uterus. It uses specific fluid preparations that are useful when consumed daily.
What If You Are Diagnosed With a Small Uterus in Pregnancy?
Defining the uterus as “small” is insufficient for doctors to make a proper decision. Further diagnosis is necessary to determine the actual condition. It could be hypoplasia, where the uterus is small due to hormonal issues. Aplasia could also be a cause, where the uterus is the same as that of a newborn child or even absent. Another condition could be infantilism, where the uterus is not larger than 55mm.
Any treatment method to increase the uterus size takes a reasonable amount of time. Using hormonal medication is a standard method for women diagnosed with hypoplasia. In some instances, being involved in sexual activity regularly can also be beneficial and could cause the uterus to increase in size gradually.
What If the Uterus Is Less Than the Gestational Age?
While detecting a small uterus before conception is one case, it might even be observed during pregnancy. An intra-uterine growth restriction may take place that limits the child from growing as large as it should be and limiting its weight.
Several factors are usually considered to determine whether the uterus size will be problematic. These are primarily the vital elements such as the amount of amniotic fluid present in the sac, the position of the foetus within the uterus, the size it has grown to depend on the pregnancy’s progress, and so on.
Any case of a small uterus will be examined with proper ultrasound tests, which might be followed by a colour-doppler for more details.
FAQ
1. Does Small Uterus Increase the Risk of Miscarriage?
A small uterus, or a hypoplastic uterus or uterine hypoplasia, is characterised by a smaller-than-average uterus. While the size of the uterus can potentially affect a woman’s reproductive health, it is essential to note that the relationship between a small uterus and the risk of miscarriage is not well-established. Miscarriages can occur due to various factors, including genetic abnormalities, hormonal imbalances, uterine abnormalities, maternal health conditions, and lifestyle factors. Uterine abnormalities, such as a small uterus, can potentially contribute to an increased risk of miscarriage, but it is not the sole determining factor. However, many women with small uteruses have successful pregnancies and deliver healthy babies without complications.
A small-sized uterus and pregnancy may not exactly be conducive to each other. But if your doctor suggests everything will be fine, there is no need to worry. Using a few techniques, your pregnancy can proceed safely and give your baby the life he deserves.
References/Resources:
1. Does a small uterus affect fertility?; Vinmec Health Clinic; https://www.vinmec.com/en/news/health-news/obstetrics-gynecology-and-assisted-reproductive-technologies-art/does-a-small-uterus-affect-fertility/
2. itayama. R; A Case of Miscarriage Caused by a Small Uterus following Childhood Chemotherapy; Case report on Oncology; https://karger.com/cro/article/12/2/443/91251/A-Case-of-Miscarriage-Caused-by-a-Small-Uterus; June 2019
3. Bhagavath B, Ellie G, Griffiths KM, et al.; Uterine malformations: an update of diagnosis, management, and outcomes; Obstetrical & Gynecological Survey; https://journals.lww.com/obgynsurvey/abstract/2017/06000/uterine_malformations__an_update_of_diagnosis,.16.aspx; June 2017
4. Vaz S. A, Dotters-Katz S. K, Kuller J. A; Diagnosis and management of congenital uterine anomalies in pregnancy; Obstetrical & Gynecological Survey; https://journals.lww.com/obgynsurvey/abstract/2017/03000/diagnosis_and_management_of_congenital_uterine.20.aspx; March 2017
Also Read:
Bicornuate(Heart Shaped) Uterus
Different Types of Uterus Abnormalities?
Blood Clot in the Uterus when Pregnant
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Cervical Cancer During Pregnancy
Unlike most other types of cancer, cervical cancer is a type of cancer that can be treated if it is detected and prevented early-on. Many countries include a cervical cancer diagnosis before providing consultations for pregnancy, thus lowering the risk of cervical cancer and ensuring a hassle-free pregnancy. By nature, cervical cancer does not affect the baby or influence the delivery in any way in the early stages; however, in its advanced stages, the treatment becomes a necessity as it has been known to be harmful to mothers. Read on to know more.
What Is Cervical Cancer?
Cervical cancer is basically cancer of the uterus. The ailment starts when the cells in the cervix start multiplying unhindered. They grow and reach a pre-cancerous stage, from where they soon begin multiplying rapidly. In some cases, these cancer cells multiply to an extreme stage really fast within a year, while usual case reports indicate that it takes years for the cells to go from pre-cancerous to the cancerous stage.
How Common Is Cervical Cancer During Pregnancy?
Cervical cancer during pregnancy is uncommon and affects about 1 to 3 percent pregnant or postpartum women. Around half the cases are diagnosed in the prenatal stages, while the other half, in the 12 months after childbirth.
Causes of Cervical Cancer in Pregnancy
In a healthy system, cells divide and die. When cells stop dying and start multiplying rapidly, they cause abnormal growth. Lumps form in the cervix and eventually mature into tumour cells. These cells become cancerous later on, thus leading to cervical cancer in women.
There are several causes of cervical cancer in pregnancy. They are:
Having multiple sexual partners
Becoming sexually active early on
Weak Immune System
HIV or AIDs
Self-destructive behaviours like drinking/drugs and long-term mental stress
Several pregnancies
STDs (Sexually Transmitted Diseases) like Chlamydia, gonorrhoea, and syphilis
Early pregnancy beforehand (usually before the age of 17 years)
Smoking
Taking birth control pills
HPV (Human Papillomavirus) Infections
There are 100 types of HPV infections, and 13 of these are known to contribute to the development of cervical cancer.
Symptoms of Cervical Cancer
Symptoms of cervical cancer range from:
Pain during sexual intercourse.
Pain in the lower belly and pelvis.
Abnormal Vaginal bleeding during douching, sex, or in between menstrual periods.
Abnormal vaginal discharge.
Diagnosis
Cervical cancer during pregnancy is diagnosed through a pap smear test. The doctor uses a special magnifying instrument known as the colposcope to scrape for cells from the cervix which are then tested. Women aged 21 and below usually undergo a diagnostic test to check for pre-cancerous cells, irrespective of pregnancy.
For obtaining tissue samples, your doctor may use:
Punch Biopsy – For this procedure, a sharp tool is used to pinch out small samples of cervical tissue.
Endocervical Curettage – For this, a curet (spoon-shaped instrument) or thin brush is used to scrape off tissue samples from the cervix.
Electrical Wire Loop – A low-voltage electrical wire is slipped into the cervix for collecting tissue samples. Local anaesthesia is used in this method.
Cone Biopsy – It is a procedure that goes into the deeper layers of the cervix for collecting tissue samples for laboratory testing. It is performed in hospitals under general anaesthesia.
Another form of diagnosis is the HPV DNA Infection test which scans for abnormalities in cells that match any types of HPV infections. HPV infections are known to lead to cervical cancer, and testing for HPV abnormalities in cervix cells is the second type of diagnosis.
If your doctor detects cervical cancer through laboratory testing or hospital diagnosis, then a further diagnosis will be carried out to determine the stage and extent of your cervical cancer. Common staging exams are:
Imaging Tests – X-rays, CT scans, Magnetic Resistance Imaging (MRI) and positron emission tomography (PET) for determining how far cancer has spread from the cervix.
Visual Examination – Special scopes are used for scanning areas inside the bladder and rectum to check the extent and condition of cervical cancer
What Is Cervical Dysplasia?
When abnormal cell growth occurs in the outer lining of the cervix, this condition is referred to as a Cervical dysplasia. Cervical dysplasia is a pre-cancerous stage and is heavily associated with the sexually transmitted Human Papillomavirus (HPV) infection. It is known to develop at any age and commonly found in women aged 30 and below. Cervical dysplasia usually has no symptoms and is detected through routine Pap tests during pregnancy.
Cervical dysplasia, when left unchecked, later transitions into full-blown cervical cancer.
What Happens After Diagnosis?
Treatment after a diagnosis depends on the severity and extent of cervical dysplasia. For mild conditions, continued routine monitoring with repeat Pap tests ensues, while for severe conditions, treatments such as cryosurgery, Electro-cauterization, and laser surgery are used.
After treatment, follow-up with respective doctors is necessary along with a repeat Pap test or an HPV DNA test between six to twelve months.
Can Chemotherapy Affect the Unborn Baby?
Chemotherapy during the first trimester of pregnancy is harmful to the foetus as the organs are developing during that stage. Chemotherapy does not affect the baby during the second trimester as the placenta acts as a barrier to protect the baby from the side effects of chemotherapy and also prevents certain drugs from entering the bloodstream.
During the later stages of pregnancy, chemotherapy may indirectly harm the unborn baby by causing side effects in the mother.
Risk Factors
Risk factors associated with chemotherapy treatment include:
Loss of foetus.
Birth defects in the newborn.
Low blood cell count during delivery.
Increased risk of cervical infections.
Treatment Options
Alternative treatment options for chemotherapy treatment include:
Chemotherapy combined with radiation therapy treatment
Herbs and certain vitamins
Changing your diet
Acupuncture and massage
Clinical trials
Clinical trials involve special untested procedures used in research studies to discover alternative methods of cancer treatment. Although useful, they may also prove to be dangerous.
Do speak with your doctor or concerned medical specialist before opting for any of these alternative treatment methods as some of them are complementary and may not be medically-approved.
Treatment of Cervical Cancer Based on Different Stages of Pregnancy
The treatment of cervical cancer is based on the location of the tumour, the stage of cervical cancer, your overall health, and the particular trimester of pregnancy you’re currently in. The treatment modes for different stages of pregnancy for mothers affected by cervical cancer are:
Treatment of Cervical Cancer in Early Stages of Pregnancy
Routine Pap tests followed by a biopsy are used for the treatment of cervical cancer in the early stages of pregnancy. Surgery may be done during this stage which involves removing the tumour and surrounding healthy tissue in the cervix. This is invasive and poses little risk to the mother and the baby.
If your cervical cancer is in its earliest stages during pregnancy, your doctor may postpone treatment after a healthy delivery due to no threat to the pregnancy. After pregnancy, you may be subject to a hysterectomy (removal of the uterus) based on how far cancer has progressed after your pregnancy.
Treatment of Cervical Cancer in Second and Third Trimester
Chemotherapy may be combined with radiation therapy to provide the necessary treatment during these stages. These treatment methods are usually safe and do not harm the foetus during the second and third trimesters.
Pregnant Women Who Have Small Tumours
For small tumours, there are two treatment options available for mothers-to-be: a cone biopsy, and a trachelectomy. Since a trachelectomy poses a risk to the unborn baby and may cause foetal demise during the operation, it is avoided during pregnancy. A cone biopsy is a preferred method in which a conical section of tissue is removed from the cervix for examination and diagnosis.
Pregnant Women Having Large Tumours
Your doctor will recommend chemotherapy for treating large tumours. You will either be advised to opt for early delivery or wait until the second or third trimester to start with this treatment.
Precautions
There are no methods known for completely treating cervical cancer in pregnant mothers. Treatment methods will vary based on the stage and extent of cancer, and the overall health of the patient. Findings from studies and data from clinical trials performed on previous non-pregnant cervical cancer victims are used to assist with treatment or delay cervical cancer therapies during pregnancy.
Your doctor may advise you to abort the pregnancy if your cervical cancer has progressed to the most advanced stages of your pregnancy.
Prevention
There are many ways to prevent cervical cancer from developing. The primary method is treating it as soon as it is detected, if possible, before the pre-cancerous stage and not letting it mature any further. The most common methods of prevention are:
Using condoms during sexual intercourse.
Avoiding early sexual contact or not having sex with multiple partners.
Eliminating smoking/drug abuse.
Avoiding skin-to-skin contact with someone who already has an HPV infection.
Routine HPV vaccination starting between ages 9 to 12.
It is recommended that every woman should undergo routine Pap testing (Pap smear) or HPV DNA Testing to diagnose signs/symptoms of cervical cancer. Routine vaccination is even recommended for those who have sex with multiple partners even beyond the age of 21 and above to prevent pre-cancerous stages from developing.
Make an appointment with your doctor and attend regular Pap screening tests to prevent the chances of cervical cancer from developing. By adopting a healthy lifestyle, not smoking, and ensuring you’re not sexually active before 21, you will greatly diminish the probability of Cervical Dysplasia from occurring. Routine vaccinations are also important for the prevention of HPV infections and cervical dysplasia.
During treatment, you may ask your doctor for palliative care, which is known to provide relief from pain and other symptoms of serious illnesses.
We recommend you ask for a second healthcare provider’s opinion when considering attending an examination for the diagnosis of cervical cancer. Sit with your doctor and ask about the treatment options available to you if you are diagnosed with cervical cancer during pregnancy since treatment methods differ according to individual medical profiles.
Also Read: Uterine Fibroids During Pregnancy
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Hepatitis B in Pregnancy – Symptoms, Effects, & Treatment
Hepatitis B in pregnancy can increase the risk of mother-to-child transmission, but timely screening, appropriate treatment, and preventive measures can significantly reduce complications for both mother and baby. According to the World Health Organization (WHO), hepatitis B affects an estimated 254 million people globally, and mother-to-child transmission during birth remains one of the most common routes of infection (1). Additionally, infants infected at birth have about a 90% risk of developing chronic hepatitis B if preventive measures are not taken (2).
This article explains everything you need to know about hepatitis B and pregnancy, including its symptoms, risks, diagnosis, treatment options, and the role of the hepatitis B vaccine in pregnancy in preventing mother-to-child transmission and protecting newborn health.
What Is Hepatitis B?
Hepatitis B is the term used for describing inflammation of the liver, and is caused by a virus. It is usually transmitted through body fluids like blood, vaginal fluids or semen (3). It can be warded off sooner if you have a good immune system. Often, infected people tend to carry the virus leading them to suffer from chronic Hepatitis. It may cause serious damage to the liver. This damage can be slowed down by getting good medical care and following a healthy lifestyle.
Types of Hepatitis B Infections
Hepatitis B infection can present in different forms depending on how long the virus remains in the body and how the immune system responds to it. The following are the main types of hepatitis B infections (4).
1. Acute Hepatitis B Infection
Most adults who are infected have the acute Hepatitis B infection. Their immune system can usually clear the virus from the body in about 2-3 months. In some cases, it may lead to chronic infection.
2. Chronic Hepatitis B Infection
When one’s immune system is incapable of fighting off the acute Hepatitis infection, and it lasts for 6 months or more, it results in chronic Hepatitis B infection. This can lead to major complications such as liver cancer or cirrhosis.
Hepatitis B & Pregnancy
If you are pregnant with Hep B, you hold the risk of passing on the virus to your baby (5). To prevent such situations, a routine blood test is recommended for all pregnant women to determine the presence of Hepatitis B. A Hepatitis B reactive or HBsAg positive would mean the presence of Hepatitis B virus in the blood (6). In case you have the virus, there are certain vaccinations which can be administered post-delivery, which protect your baby. There are even some medications and hepatitis B vaccine for pregnant women, for those whose virus levels are high.
How Common Is Hepatitis B?
About 10-15% of the world’s population is carriers of Hepatitis B. It is quite prevalent in India where around 100,000 Indians die from Hepatitis infection every year. Besides, it is one of the major causes of liver cancers, chronic liver disease and cirrhosis (7).
Should Pregnant Women Tested for Hepatitis B?
In immune-competent adults, an acute Hepatitis B virus is likely to be cleared soon. But through perinatal transmission of HBV, children carry a high risk of illness like liver carcinoma and liver cirrhosis. About 90% of babies infected at delivery tend to become chronic carriers of the virus (5).
Hence, if you are pregnant, it is necessary to get tested for Hepatitis B infection. If you are infected with HBV, you should focus on preventing transmission of the virus to your baby.
How Does HBV Spread?
Hepatitis B virus is most commonly spread if you come in contact with body fluids like blood, saliva or semen of infected persons. However, it can be difficult to detect the exact cause of HBV, for it takes a long time to showcase its signs. The most common ways in which the virus may spread are (8):
Medical or dental treatment in a place where sterilisation does not take place properly.
Having a blood transfusion without examining the blood for the presence of the virus.
Mother to child a pregnant woman, who is infected with HBV, may transmit the virus to her baby during delivery or post-delivery.
Sharing of Needles using shared needles or syringes for injections.
Sexual contact having unprotected sex with a hep B-infected person.
Through needle injury to persons working in a healthcare division.
Infected blood getting in your body through some open wound or scratch.
Through contaminated needles used for piercing and tattoos.
Sharing a razor or toothbrush with an infected person.
Accidental needle sticks it is a major concern for those working in healthcare centres and others who come in contact with human blood.
Symptoms of Hepatitis B in Pregnancy
Many times, pregnant women are unaware that they are infected with HBV. It is because symptoms of Hepatitis B are hard to diagnose. They appear at a later stage and may be felt only vaguely. The symptoms become noticeable almost 2-3 months after being infected by the virus. Although, there are cases where some of the signs tend to come and go. Some of these include:
Abdominal pain
Fatigue
Nausea
Stomach ache
Diarrhoea
Vomiting
Loss of appetite
Jaundice
Fever
Difficulty in breathing
Effect of Hepatitis B on Pregnancy & Baby
Generally, if you are infected with Hepatitis B in pregnancy, it doesn’t have any adverse effect on the unborn baby. But this depends on the viral load in your blood. If the level is high, there are slight chances of your baby getting affected before birth. In case of acute infection, there are increased chances of low birth weight and premature birth, whereas, for the mother, the possible effects of HBV infection include gestational diabetes mellitus and antepartum haemorrhage (9).
The baby is at utmost risk during the delivery as he is exposed to maternal blood and faeces. If the baby gets infected at that stage and goes untreated, he is at risk of developing a lifelong liver disease. Hence, it is essential that the mother gets Hepatitis B therapy while pregnant, to lower the risk of passing on the infection to the baby.
Can You Breastfeed With Hepatitis B?
In normal cases, breastfeeding by an infected mother does not stimulate the transmission of HBV to the baby. It is because the baby is already exposed to the virus at delivery and hence, immunised at birth with hep B vaccinations. But it is strictly recommended that the mother take good care of her nipples throughout the period of breastfeeding (10). If the nipples crack or bleed, there arises the risk of transmitting HBV to the baby through blood. In such cases, the mother should bottle-feed the baby with either the expressed milk or formula milk until the nipples heal.
Risk of Mother to Baby Transmission
A pregnant woman is usually recommended to get HBsAg test done. For, if she is infected with HBV, there is a high risk that she may pass on the virus to the baby. There are three main ways in which transmission of HBV may take place. These are (11):
Transplacental Transmission of HBV In Utero
In general, it is difficult for the virus to cross the placenta in the womb. However, there are cases, when it may happen. The possible causes for intrauterine transmission of Hepatitis B virus are listed as follows:
A breach of the placental barrier
Placental infection
Transmission During Delivery
The baby is at optimum risk of catching the Hepatitis B virus from the mother during this period. The reasons for transmission of HBV during birth are:
Exposure to the cervical secretions of the infected mother
Exposure to maternal blood containing the virus
Postnatal Transmission During Care or Through Breastfeeding
Breast milk of an infected mother does not pose a risk to the infant but bleeding nipples can infect the baby. It is recommended that the mother safeguard her nipples while breastfeeding. She should ensure proper latch-on and allow the nipples to dry to avoid cracking or bleeding as HBV can be transmitted through blood (10).
Treatment of Hepatitis B in Pregnancy
When you are tested positive for Hepatitis B in early stages of pregnancy, doctors may recommend certain blood tests. Depending on viral load in your system and whether it’s acute Hepatitis B reactive or a chronic one, you may be prescribed a shot of the vaccine Hepatitis B immune globulin (HBIG). This vaccine contains antibodies against the Hepatitis B virus and thus, gives additional protection (12).
As per the severity of your infection, you may be required to undergo following treatments:
Antiviral Medications
There are certain drugs that have been approved by the FDA for treatment of Hep B in pregnancy.
The side effects include vomiting, feeling sick and dizziness. These drugs have to be taken as per doctor’s advice.
Hepatitis B & Pregnancy Complications
Hepatitis B is an endemic liver infection, caused when the person is infected with Hepatitis B virus. For most adults with strong immune system, recovery is within 2-3 months. But for those women for whom the infection has lasted for about 6 months, it results into a chronic Hepatitis B. This increases the risk of permanent scarring of the liver. Certain complications may develop as indicated below:
1. Acute Fatty liver
This condition arises when you have had the infection for a long period and the liver has been affected by cirrhosis. The increased demands on your liver during pregnancy causes this additional health issue. Sometimes this condition may escalate and become severe. In such case, you will require immediate medical intervention and may be suggested early delivery. It is recommended you pay attention to your diet and intake foods that are liver friendly.
2. Gallstones (Cholelithiasis)
It is found among approximately 6% of pregnancies. This occurs due to change in bile salts during pregnancy. In a pregnant woman, the gallbladder slows down. As a result, the emptying process happens slowly and causes collection of bile salts for a longer duration. This condition can cause jaundice or may worsen, where removal of gall bladder becomes necessary (13).
3. Cirrhosis
Cirrhosis defines scarring of the liver and affects one in five people suffering from chronic Hepatitis B. Its symptoms get noticeable very late when extensive damage has already been done to the liver. At such a stage, it causes weight loss, sickness, itchy skin, swelling in the tummy and ankles, loss of appetite and fatigue (14).
4. Hepatocellular Carcinoma or Liver Cancer
One in 20 people suffering from cirrhosis have the potential to develop liver cancer. Symptoms for liver cancer include feeling sick, unexplained weight loss, jaundice and loss of appetite (15).
5. Liver Failure
This condition arises when almost all the vital parts of the liver stop functioning. In such a case, liver transplant becomes mandatory to sustain life.
6. Fulminant Hepatitis B
In some cases, acute Hepatitis B can get elevated to a serious problem of fulminant Hepatitis B. This is a rare condition and it happen s about 1 in 100 cases. In this circumstance, the immune system itself attacks the liver and causes serious damage, requiring prompt treatment. Its symptoms include severe jaundice, delirium, collapsing and swelling of the tummy (16).
Precautions for Hepatitis B While Pregnant
Hepatitis B vaccines are available to guard the babies against being infected by Hepatitis B. Those are given to them as per the routine vaccination schedule for babies. Apart from the vaccinations, there are general precautionary measures to be considered. It is advisable that the following points are taken seriously, so that you can reduce the risk of getting infected (17).
1. Know the HBV status of your partner.
It is highly recommended that you stay away from unprotected sex, unless you are sure that your partner is clear from all infections.
2. Use a latex or polyurethane condom during each intercourse.
If you are unaware of the HBV status of your partner, try not to rely completely on any condom. Though condoms can reduce the transmission risk, there can be exceptions. Prefer only the branded ones and use a new one for each time.
3. Avoid using illicit drugs.
Keep away from taking unnecessary drugs without doctor’s prescription. Even if you have to take the injection, ensure that you use a sterile needle. Do not share the used needles.
4. Be careful about piercings or body tattoos.
If you wish to get any piercings or tattoo done on your body, prefer a reputed centre. Ask in detail about the equipment used and its cleaning methods. Make sure that sterile needles are used. If not, you should look for other options.
5. Don’t share personal belongings.
Do not share razor blades or toothbrushes, as they might carry traces of infected blood. Any open sores, abrasions or cuts should be immediately covered with a waterproof dressing.
6. Enquire about Hepatitis B vaccine before your travel.
When planning to travel to someplace, where Hepatitis B is common, consult your doctor regarding hepatitis B vaccination.
Post Pregnancy Follow-Up
At the time of birth, the baby should be given two injections, which are a dose of Hepatitis B and a dose of Hepatitis B immune globulin. These shots should be administered within the first 12-hour period immediately after delivery. With these two injections, there is a 90% chance of protecting the baby against lifelong Hepatitis B infection. Apart from these doses, two more doses are given. One is given at 2-3 months of age and the next at 6 months. Babies born to an HBsAg-positive mother, should be strictly followed up for medical review.
This follow-up should be timed after 2 months of initial immunisation course, which lasts for 8 to 12 months. During this follow-up, the baby’s blood should be tested for presence of Hepatitis B virus. If the mother is infected, she needs to be followed up post pregnancy every 12 months. This is done to assess their viral markers and liver functioning.
FAQs
1. Is the hepatitis B vaccine safe during pregnancy?
The hepatitis B vaccine is generally considered safe during pregnancy and may be recommended for pregnant women who are at increased risk of infection. A healthcare provider can determine whether vaccination is appropriate based on individual circumstances.
2. Can hepatitis B affect future pregnancies?
Most women with well-managed hepatitis B can have healthy future pregnancies. Informing healthcare providers about the infection before or during future pregnancies helps ensure appropriate monitoring and preventive measures are in place.
3. Can hepatitis B cause miscarriage?
Hepatitis B is not generally considered a direct cause of miscarriage. However, severe liver disease or pregnancy-related complications associated with hepatitis B may increase health risks for both the mother and the baby.
Prenatal care to check the risk of such infections is a must for every pregnant woman. Even if they are previously vaccinated or tested, a mandatory test for the virus in the first trimester is an absolute essential.
Also Read:
STD during Pregnancy
Hepatitis C in Pregnancy
Cytomegalovirus while Pregnant
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