Obstetrical Risk Assessment: Fill & Download for Free

Many Hepatitis B (HBV) carriers are asymptomatic and unaware they're HBV positive. This is accompanied by ignorance that HBV can spread sexually (horizontally) (1, 2, 3, 4, 5, 6). One case report from Japan suggests this can even happen several decades later (7). Thus, HBV continues spreading to sexual partners. HBV's also transmitted vertically (perinatally from mother to child during birth or through breast milk) (8, 9), another seriously worrying issue for an HBV positive adult.Sounds like you're already several steps ahead. You know your HBV status and likely intend to proactively minimize risk to your future spouse and children, else you wouldn't be asking this question. Certainly, no bar to marriage and children since prophylaxis, i.e., disease prevention, to protect spouse and children greatly reduces their risk of HBV infection.What type of prophylaxis? Answer depends on your status: asymptomatic, chronic carrier, HBsAg+, HBsAg+ and HBeAg+, liver function test results, presence/absence of anti-HBV antibodies, to mention some of the most important factors. Attending physician should screen and periodically perform risk assessment to determine whether situation mandates spouse and child prophylactic vaccination alone or Rx with hepatitis B immunoglobulin and anti-virals as well. This means regular screening for you, the index case, your spouse and future children.What are rates of sexual transmission from infected to uninfected partner? What does HBV prophylaxis consist of for high-risk individuals (partners and children of HBV positive individuals) and how effective is it? These are some of the most pertinent questions for which the scientific literature has some answers.Rates of sexual transmission vary in different studiesAs few as ~5% in an Israeli survey (10).As many as 65% within two years of marriage in a Chinese survey (11).In an Iranian study (12),~65% in husbands of infected wives~46% in wives of infected husbandsMore efficient female-to-male HBV transmission has also been reported in Turkey (13).Selective vaccination of high-risk groups in Netherlands reduced HBV transmission (14). High-risk in this study meant men who have sex with men, drug users, commercial sex workers, heterosexuals with frequent partner changes.What about child/children? Vaccinate or vaccinate plus hepatitis B immunoglobulin post-birth? Decision depends on results of regular screening and risk factor assessment during pregnancy by attending physician (15).HBV vaccine is most effective in preventing vertical transmission when 1st dose is given within 24 hours of birth (16).2nd vaccine dose should be within 10 weeks of 1st dose, especially if hepatitis B immunoglobulin isn't given at birth (17).Timing is also important for hepatitis B immunoglobulin to be effective. Works best within 48 hours after single unprotected sexual exposure or parental exposure, not much use if given after >7 days (18).Treat pregnant mother with anti-viral as well? Again, decision needs to be made after consulting attending physician and is based on mother's HBV infection level. Is infection asymptomatic or chronic?For e.g., anti-viral lamivudine's effective in mothers with high levels of HBV viral DNA in the 3rd trimester (19).OTOH, if mother is circulating HBV antigen positive, i.e., HBsAg and HBeAg, 70 to 90% of her children will become HBV infected without immunoprophylaxis (20) while 5 to 20% children will be infected if mother is HBsAg+ but HbeAg- (21), i.e., much higher % children become infected if mother's positive for both HBsAg and HBeAg compared to HBsAg alone (22). At birth HBV vaccine of children born to HBsAg+ mothers greatly reduces transmission, >50 to >80% depending on vaccine used (23).So, this brief summary shows several options available to you and your future spouse and children. As well, many if not most countries have adopted universal childhood vaccination against HBV so children would anyway get vaccinated. Depending on your infection status, regular monitoring and risk assessment by attending physician would suggest whether spouse and children would need additional prophylaxis (immunoglobulin, anti-virals).Bibliography1. Inaba, N., et al. "Sexual transmission of hepatitis B surface antigen. Infection of husbands by HBsAg carrier-state wives." The British journal of venereal diseases 55.5 (1979): 366-368. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1045683/pdf/brjvendis00035-0054.pdf2. Alter, Miriam J., et al. "Hepatitis B virus transmission between heterosexuals." Jama 256.10 (1986): 1307-1310.3. Ko, Ying‐Chin, et al. "Female to male transmission of hepatitis B virus between Chinese spouses." Journal of medical virology 27.2 (1989): 142-144.4. Alter, Miriam J., et al. "Importance of heterosexual activity in the transmission of hepatitis B and non-A, non-B hepatitis." Jama 262.9 (1989): 1201-1205.5. Davis, L. Gray, DavidJ Weber, and StanleyM Lemon. "Horizontal transmission of hepatitis B virus." The Lancet 333.8643 (1989): 889-893.6. Struve, Johan, et al. "Heterosexual contact as a major route for transmission of acute hepatitis B among adults." Journal of Infection 20.2 (1990): 111-121.7. Okamoto, Daisuke, et al. "Molecular analysis of the interspousal transmission of hepatitis B virus in two Japanese patients who acquired fulminant hepatitis B after 50 and 49 years of marriage." Journal of medical virology 86.11 (2014): 1851-1860.8. Toy, Mehlika, et al. "Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands." Journal of medical virology 80.3 (2008): 399-404. http://repub.eur.nl/pub/51635/110607_Toy-Mehlika.pdf#page=199. Cheung, K. W., M. T. Y. Seto, and S. F. Wong. "Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy." European Journal of Obstetrics & Gynecology and Reproductive Biology 169.1 (2013): 17-23. http://www.pfizerpro.com.co/sites/g/files/g10020151/f/publicaciones/2013_169_1_Towards-complete-eradication-of-hepatitis-B-infection-from-perinatal-transmission-review-of-the-mechanisms-of-in-utero-infection-and-the-use-of-antiviral-treatment-during-pregnan.pdf10. Zamir, D., C. Zamir, and S. Rishpon. "Epidemiology of hepatitis B virus infection among family members of chronic carriers in Israel." The Israel Medical Association Journal: IMAJ 3.5 (2001): 338-340. http://www.forum.ima.org.il/FilesUpload/IMAJ/0/57/28988.pdf11. Hesketh, Therese. "Getting married in China: pass the medical first." BMJ: British Medical Journal 326.7383 (2003): 277. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125129/pdf/277.pdf12. Roushan, Mohammad Reza Hasanjani, Minoo Mohraz, and Ali Akbar Velayati. "Possible transmission of hepatitis B virus between spouses and their children in Babol, Northern Iran." Tropical doctor 37.4 (2007): 245-247.13. Erol, Serpil, et al. "Intrafamilial transmission of hepatitis B virus in the eastern Anatolian region of Turkey." European journal of gastroenterology & hepatology 15.4 (2003): 345-349.14. Hahné, Susan, et al. "Selective hepatitis B virus vaccination has reduced hepatitis B virus transmission in the Netherlands." PloS one 8.7 (2013): e67866. http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0067866&representation=PDF15. Wong, VivianC W., et al. "Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin: double-blind randomised placebo-controlled study." The Lancet 323.8383 (1984): 921-926.16. Lee, Chuanfang, et al. "Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis." Bmj 332.7537 (2006): 328-336. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1363909/pdf/bmj33200328.pdf17. Tharmaphornpilas, Piyanit, et al. "Increased risk of developing chronic HBV infection in infants born to chronically HBV infected mothers as a result of delayed second dose of hepatitis B vaccination." Vaccine 27.44 (2009): 6110-6115. http://thaigcd.ddc.moph.go.th/uploads/knowledge/4e27af902aa5b.pdf18. Zuckerman, J. N. "Review: hepatitis B immune globulin for prevention of hepatitis B infection." Journal of medical virology 79.7 (2007): 919-921.19. Xu, W‐M., et al. "Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double‐blind, placebo‐controlled study." Journal of viral hepatitis 16.2 (2009): 94-103.20. Stevens, Cladd E., et al. "HBeAg and anti‐hbe detection by radioimmunoassay: Correlation with vertical transmission of hepatitis B virus in Taiwan." Journal of medical virology 3.3 (1979): 237-241.21. Mahoney, Francis J. "Update on diagnosis, management, and prevention of hepatitis B virus infection." Clinical microbiology reviews 12.2 (1999): 351-366. Update on Diagnosis, Management, and Prevention of Hepatitis B Virus Infection22. Chen, Huey–Ling, et al. "Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV." Gastroenterology 142.4 (2012): 773-781.23. Xu, Zhi-Yi, et al. "Prevention of perinatal acquisition of hepatitis B virus carriage using vaccine: preliminary report of a randomized, double-blind placebo-controlled and comparative trial." Pediatrics 76.5 (1985): 713-718.Thanks for the A2A, Pratap Singham.

I have no idea where this question is written, but it does not sound to be American English. Call your nearest medical school and see if they have specialists in “High Risk Obstetrics” and geet under the appropriate care.The only thing I was able to figure out from your description, but she probably bled a lot. Get a real assessment.

The short answer is: the ACA.Insurance companies set their premium rates based on actuarial prediction of future payouts for individuals in groups. If person “A” has had three previous auto accidents, “A” is more likely to have another one than person “B” who has never been in a crash. Auto insurance companies would therefore charge “A” more for insurance as they are more likely to have to spend more on “A” than on “B” who would be charged a lower premium rate. That is auto underwriting based on risk assessment.If the same principle were used in healthcare, those with expensive (“high risk”) pre-existing conditions would have to pay much higher premiums than the healthy, “low risk,” non-smoking 50-year old marathon runner. This is called medical underwriting and is prohibited by the ACA.That is how the ACA keeps the rates for those pre-existing low, by raising the rates of everyone else. That is also the first reason why your insurance premiums more than doubled due to Obamacare. The second reason is increased benefits that insurance companies are supposed to provide by law. Never mind that fact that my wife and I, ages 73 and 76, have to pay for benefits for prenatal care and obstetrical services.By the way, before the ACA, those with high-risk (of high cost), pre-existing conditions were cared for in high-risk pools and the general public did not have to pay the current astronomical insurance premiums. The narrative that they weren’t getting care is political B.S.Deane Waldman, MD MBA, Emeritus Professor of Pediatrics, Pathology, and Decision Science; author of, “Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.” Download free Healthcare Decoder and other no-charge bonus items at: www.deanewaldman.com.