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46: Vertical transmission of hepatitis C

      Objective

      To determine vertical transmission rates of hepatitis C over a 5 year period in two tertiary level maternity units

      Study design

      Retrospective review of all hepatitis C positive mothers and their pregnancy outcomes in two Dublin maternity units over a 5 year period from 2001-2005 inclusive.

      Results

      During the study period there were 74,629 deliveries. A total of 473 Hepatitis C positive mothers were identified, who were delivered of 559 liveborn infants, rate of hepatitis C infection was 0.75% (559/74629). 458 infants were delivered to Irish mothers (81.9%). Of the 559 liveborn infants, maternal hepatitis C PCR was detected in 294 (52.5%), undetected in 167 (29.8%), not tested in 93 (16.6%), sample unsuitable for analysis in 3 (0.5%), and no data available for 2 (0.33%) In the neonatal period 367 infants tested negative for hepatitis C PCR, 18 positive and 173 infants did not get tested/were lost to follow-up. The vertical transmission rate is thus 18/385 (4.7%). Overall the caesarean section rate was 20.9%, instrumental delivery rate was 9.4%. One intrapartum fetal blood sample was performed (maternal PCR status unknown, baby PCR negative) and 23 babies had fetal scalp electrode applied, none of these infants subsequently were identified as PCR positive; 9 tested negative, 14 did not have infant PCR checked.

      Conclusion

      This study, one of the largest in the literature, reports a vertical transmission rate for hepatitis C of 4.7%. This is lower than the vertical transmission rate of hepatitis B and for HIV, suggesting a lower level of infectivity despite the majority of women having hepatitis C PCR detectable. Education of labour ward staff in the importance of appropriate intrapartum management of pregnancies affected with hepatitis C may improve adherence to that general guidelines regarding avoidance of fetal blood sampling and application of fetal scalp electrodes in labour.