Toxoplasma gondii

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Visioacute obstegravetrica toxoplasmosis

Toxoplasma gondii

Importagravencia 10-50 poblacioacute infectada 15-45a 75-90 seronegatives embaragraves (12 espanyoles vs 41 immigrantes i 0 asiagravetiques) TXP congegravenita 03x 1000 Dinamarca coriorretinitis 1 Europa vs 20 Brasil

McAuley JB Congenital Toxoplasmosis J Pediatric Infect Dis Soc 2014 3(Suppl 1)S30-S35 Lindsay DS Dubey JP Toxoplasma Gondii the changing paradigm of congenital toxoplasmosis Parasitology 20111381829-31

La diferencia en la infectivitat depegraven de 1- reactivacioacute 2- diferents genotips T Gondii En diferents parts del mon Aixograve pot explicar les diferegravencies en els diferents paiumlsos en la incidegravencia i gravetat de la TXP congegravenita i els diferents protocols drsquoactuacioacute

2010

2010

2005

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Toxoplasma gondii

Importagravencia 10-50 poblacioacute infectada 15-45a 75-90 seronegatives embaragraves (12 espanyoles vs 41 immigrantes i 0 asiagravetiques) TXP congegravenita 03x 1000 Dinamarca coriorretinitis 1 Europa vs 20 Brasil

McAuley JB Congenital Toxoplasmosis J Pediatric Infect Dis Soc 2014 3(Suppl 1)S30-S35 Lindsay DS Dubey JP Toxoplasma Gondii the changing paradigm of congenital toxoplasmosis Parasitology 20111381829-31

La diferencia en la infectivitat depegraven de 1- reactivacioacute 2- diferents genotips T Gondii En diferents parts del mon Aixograve pot explicar les diferegravencies en els diferents paiumlsos en la incidegravencia i gravetat de la TXP congegravenita i els diferents protocols drsquoactuacioacute

2010

2010

2005

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

2010

2010

2005

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

2010

2005

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

2005

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Toxoplasma gondii

Criteris cribratge prenatal

The condition is an important public health problem The natural history is well understood A safe valid and reliable screening test is available which is acceptable to those being tested

Treatment or an intervention of proven effectiveness is available

The risk of harm both physical and psychological is less than tne chance of benefit

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Toxoplasma gondii

Transmissioacute carn crua o fruits o vegetals contaminats aigua no filtrada

Taxa infeccioacute 1-8 x 1000 embarassos susceptibles

TV (gt transmissioacute gtsetmanes)

Risc TV Risc sequumleles

7-15 setm 6-26 13 setm 61

26 setm 32-44

36 setm 71-93 36 setm 9

The condition is an important public health problem

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Toxoplasma gondii

SOSPITA PRIMOINFECCIOacute bull repetir Ig G en 2-3 setm x 4 veg el tiacutetol AC= sospita primoinfeccioacute bull test avidesa bull AMNIO gt18 setm i gt4 setm primoinfeccioacute si infeccioacute recent confirmada si no possible excloure infeccioacute recent si troballes ECO sospitoses

Diagnogravestic

Serologia Ig M + 10-13 mesos o anys primer trimestre IgG i IgM + (1-3 prob infeccioacute embaragraves) Test avidesa IgG pot ser baix durant anys Real time PCR S=922 E=100 S no depegraven del moment de la seroconversioacute

A safe valid and reliable screening test is available which is acceptable to those being tested

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Toxoplasma gondii

Tractament redueix alteracions neurologravegiques greus

si redueix risc de TV no redueix risc coriorretinitis pot produir aplagravesia medulmiddotlar

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

PCR (-) Espiramicina 1g8h PCR (+) Pirimetamina 50 mgdia + sulfadiazina 3gd + ac foliacutenic 25mgd alternsetm Espiramicina 1g8h

Espiramicina macrogravelid que no travessa placenta perograve que es concentra en la placenta serveix per prevenir la infeccioacute (eficagravecia de aprox 60)

Trials screening prenatal i tractament vs risc i benefici del tractament

Treatment or an intervention of proven effectiveness is available

Valentini P Buonsenso D Barone G et al Spiramycincotrimoxazole versus pyrimethaminesulfonamide and spiramycin alone for the treatment of toxoplasmosis in pregnancy Journal of Perinatology 20141-5

Tractament

1438 mares tractades identificades prenatalment Tractament iniciat lt 3 setm vs gt 8 setm seroconversioacute redueix TV (OR 0middot48 95 CI 0middot28mdash0middot80 p=0middot05) 550 infectats vius diagnogravestic prenatal o neonatal screening Tractament no disminueix manifestacions cliacuteniques (OR 1middot11 95 CI 0middot61mdash2middot02) gtSG seroconversioacute gt TV (OR 1middot15 95 CI 1middot12mdash1middot17) gtSG seroconversioacute lt lesions intracranials (OR 0middot91 0middot87mdash0middot95) not with eye lesions (OR 0middot97 0middot93mdash1middot00)

Interpretation Only a large randomised controlled clinical trial would provide clinicians and patients with valid

evidence of the potential benefit of prenatal treatment

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

Tractament SYROCOT

1438 mares tractades identificades prenatalment Tractament iniciat lt 3 setm vs gt 8 setm seroconversioacute redueix TV (OR 0middot48 95 CI 0middot28mdash0middot80 p=0middot05) 550 infectats vius diagnogravestic prenatal o neonatal screening Tractament no disminueix manifestacions cliacuteniques (OR 1middot11 95 CI 0middot61mdash2middot02) gtSG seroconversioacute gt TV (OR 1middot15 95 CI 1middot12mdash1middot17) gtSG seroconversioacute lt lesions intracranials (OR 0middot91 0middot87mdash0middot95) not with eye lesions (OR 0middot97 0middot93mdash1middot00)

Interpretation Only a large randomised controlled clinical trial would provide clinicians and patients with valid

evidence of the potential benefit of prenatal treatment

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

Tractament SYROCOT

Toxoplasma gondii

SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group Thieacutebaut R Leproust S Checircne G Gilbert R Effectiveness of prenatal treatment for congenital toxoplasmosis a meta-analysis of individual patients data Lancet 2007 Jan 13369(9556)115-22

Recommendation Routine antenatal serological screening for toxoplasmosis should not be offered because the risks of screening may outweigh the potential benefits

Prevencioacute Viatges a paiumlsos en desenvolupament (Sud-Amegraverica) Tocar terra i rentar-se mans Consumir carn crua (ge66ordmC) o Congelar gt24h (lt-12ordmC) Rentar-se mans al cuinar Gats canvi terra per altre persona No consum aigua no filtrada Rentar fruita i verdura Treballs jardineria

Siacute

NO SCREENING UNIVERSAL NOMEacuteS SI SOSPITA DE PRIMOINFECCIOacute

SEROLOGIA EN CENTRE REFEREgraveNCIA previ a qualsevol actuacioacute

Repetir serologies 2-3 sem si sospita infeccioacute aguda + ESPIRAMICINA

AMNIOCENTESIS a) diagnogravestic de primoinfeccioacute materna b) diagnogravestic serologravegic mare no concloent c) alteracions ECO

J Obstet Gynaecol Can 201335(1)78ndash79

SCREENING TXP ECO similar TORCH inclou ascitis HE megagravelia i RCIU

SOSPITA TXP expert en TXP

Infeccioacute materna iniciar ESPIRAMICINA

AMNIOCENTSIS gt18 setm + gt4 setm despreacutes primoinfeccioacute

J Obstet Gynaecol Can 201335(1)78ndash79

PCR LA + PIRIMETAMINA SULFADIAZINA + AC FOLINIC

NO TRACTAMENT SI infeccioacute pregravevia per TXP en immunocompetent

Screening HIV + i immunodeprimits

Primoinfeccioacute embaragraves passats 6 mesos

Informacioacute profilaxis TXP totes les gestants

J Obstet Gynaecol Can 201335(1)78ndash79

Toxoplasma gondii

Estudi cost-efectivitat Model screening franceacutes es aplicable a EEUU (seroprevalenccedila 44 en 2004) (1mes a totes seronegatives) Basa bull cost del test bull valor estadiacutestic de la vida bull seroprevalenccedila en dones en edat reproductiva bull pegraverdues drsquoembaragraves per les amnios bull incidegravencia de primoinfeccioacute per TXP durant embaragraves Segons aixograve es cost efectiu si Test de 12 dogravelars taxes de infeccioacute congegravenita de gt110000 nascuts vius

Stillwaggon E Carrier CS Sautter M McLeod R Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model PLoS Negl Trop Dis 2011 5(9) e1333

Franccedila 15 anys protocol Alt iacutendex IVE (inici programa) TC 1987 19 - 321000 nascuts vius 2007 19 - 3210000 nascuts vius

EEUU Seroprevalenccedila 15-44 anys 11 TC 110000 nascuts vius

Hepatitis B

Seguiment i tractament de la infeccioacute pel virus de la Hepatitis B en lrsquoembaragraves

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

SCREENING TXP ECO similar TORCH inclou ascitis HE megagravelia i RCIU

SOSPITA TXP expert en TXP

Infeccioacute materna iniciar ESPIRAMICINA

AMNIOCENTSIS gt18 setm + gt4 setm despreacutes primoinfeccioacute

J Obstet Gynaecol Can 201335(1)78ndash79

PCR LA + PIRIMETAMINA SULFADIAZINA + AC FOLINIC

NO TRACTAMENT SI infeccioacute pregravevia per TXP en immunocompetent

Screening HIV + i immunodeprimits

Primoinfeccioacute embaragraves passats 6 mesos

Informacioacute profilaxis TXP totes les gestants

J Obstet Gynaecol Can 201335(1)78ndash79

Toxoplasma gondii

Estudi cost-efectivitat Model screening franceacutes es aplicable a EEUU (seroprevalenccedila 44 en 2004) (1mes a totes seronegatives) Basa bull cost del test bull valor estadiacutestic de la vida bull seroprevalenccedila en dones en edat reproductiva bull pegraverdues drsquoembaragraves per les amnios bull incidegravencia de primoinfeccioacute per TXP durant embaragraves Segons aixograve es cost efectiu si Test de 12 dogravelars taxes de infeccioacute congegravenita de gt110000 nascuts vius

Stillwaggon E Carrier CS Sautter M McLeod R Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model PLoS Negl Trop Dis 2011 5(9) e1333

Franccedila 15 anys protocol Alt iacutendex IVE (inici programa) TC 1987 19 - 321000 nascuts vius 2007 19 - 3210000 nascuts vius

EEUU Seroprevalenccedila 15-44 anys 11 TC 110000 nascuts vius

Hepatitis B

Seguiment i tractament de la infeccioacute pel virus de la Hepatitis B en lrsquoembaragraves

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

PCR LA + PIRIMETAMINA SULFADIAZINA + AC FOLINIC

NO TRACTAMENT SI infeccioacute pregravevia per TXP en immunocompetent

Screening HIV + i immunodeprimits

Primoinfeccioacute embaragraves passats 6 mesos

Informacioacute profilaxis TXP totes les gestants

J Obstet Gynaecol Can 201335(1)78ndash79

Toxoplasma gondii

Estudi cost-efectivitat Model screening franceacutes es aplicable a EEUU (seroprevalenccedila 44 en 2004) (1mes a totes seronegatives) Basa bull cost del test bull valor estadiacutestic de la vida bull seroprevalenccedila en dones en edat reproductiva bull pegraverdues drsquoembaragraves per les amnios bull incidegravencia de primoinfeccioacute per TXP durant embaragraves Segons aixograve es cost efectiu si Test de 12 dogravelars taxes de infeccioacute congegravenita de gt110000 nascuts vius

Stillwaggon E Carrier CS Sautter M McLeod R Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model PLoS Negl Trop Dis 2011 5(9) e1333

Franccedila 15 anys protocol Alt iacutendex IVE (inici programa) TC 1987 19 - 321000 nascuts vius 2007 19 - 3210000 nascuts vius

EEUU Seroprevalenccedila 15-44 anys 11 TC 110000 nascuts vius

Hepatitis B

Seguiment i tractament de la infeccioacute pel virus de la Hepatitis B en lrsquoembaragraves

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Toxoplasma gondii

Estudi cost-efectivitat Model screening franceacutes es aplicable a EEUU (seroprevalenccedila 44 en 2004) (1mes a totes seronegatives) Basa bull cost del test bull valor estadiacutestic de la vida bull seroprevalenccedila en dones en edat reproductiva bull pegraverdues drsquoembaragraves per les amnios bull incidegravencia de primoinfeccioacute per TXP durant embaragraves Segons aixograve es cost efectiu si Test de 12 dogravelars taxes de infeccioacute congegravenita de gt110000 nascuts vius

Stillwaggon E Carrier CS Sautter M McLeod R Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model PLoS Negl Trop Dis 2011 5(9) e1333

Franccedila 15 anys protocol Alt iacutendex IVE (inici programa) TC 1987 19 - 321000 nascuts vius 2007 19 - 3210000 nascuts vius

EEUU Seroprevalenccedila 15-44 anys 11 TC 110000 nascuts vius

Hepatitis B

Seguiment i tractament de la infeccioacute pel virus de la Hepatitis B en lrsquoembaragraves

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

Seguiment i tractament de la infeccioacute pel virus de la Hepatitis B en lrsquoembaragraves

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

Importagravencia bull 350-360 million people

bull Prevalenccedila HbsAg UK 05-1

Italia 04 italianes i 23 immigrants

Xina 35-50 VHB c sograven de TV

Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195

Cirrosis hepagravetica

Risc cronificacioacute TV mares HBeAg + 80-90 0-6 anys risc 30 Adolescegravencia 12

x100 hepatocarcinoma

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

VHB ndash embaragraves

bull Diabetes Mellitus

bull Hemorragravegia avant-part

bull Prematuritat

bull Baix pes al neacuteixer

bull EHE

Lao TT et al Maternal hepatitis B surface antigen and incidence of pre-eclampsia J Viral Hepat 2013 20343-349 Lao TT Chan BC Leung WC et al Maternal hepatitis B infection and gestational diabetes mellitus J Hepatol 200747(1)46ndash50 Tse KY Ho LF LaoT The impact of maternal HBsAg carrier status on pregnancy outcomes a case-control study J Hepatol 200543 (5)771ndash775 Reddick KL Jhaveri R Gandhi M et al Pregnancy outcomes associated with viral hepatitis J Viral Hepat 201118(7) e394ndashe398 Safir A Levy A Sikuler E et al Sheiner E Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome Liver Int 201030(5)765ndash770 Wong S Chan LY Yu V Ho L Hepatitis B carrier and perinatal outcome in singleton pregnancy Am J Perinatol 199916(9)485ndash488

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

VHB ndash embaragraves

bull Prematuritat

bull Asfixia

Luo L Wu J Qu Y et al Association between maternal HBsAg carrier status and neonatal adverse outcomes meta-analysis J Matern Fetal Neonatal Med 2014 181-10

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

VHB - embaragraves

bull ALT increment final embaragraves i postpart

bull DNA VHB increment postpart

bull HBeAg + seroconversiograve 12-17

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

VHB ndash Profilaxi TV

profilaxi postexposicioacute

Vacuna + Immunoglobulina

5 fallo (30 en mares alta cagraverrega viral)

Nelson NP Jamieson DJ Murphy TV Prevention of Perinatal Hepatitis B Virus Transmission Journal of the Pediatric Infectious Diseases Society 2014 3(Suppl 1)S7ndashS12 Wong F Pai R Van Schalkwyk J Yoshida EM Hepatitis B in pregnancy a concise review of neonatal vertical transmission and antiviral prophilaxis Annals of Hepatology 201413(2)187-195 Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

100 TV intrauacuteter 5 TV perinatal

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

bull VHB placenta gt19 setm de gestacioacute

bull APP VHB detectable fetus

bull Cell-to-cell transfer alta taxa infeccioacute cel endotelials de la placenta (OR1846 95 IC 286-15278)

Transmissioacute intrauacuteter

Hepatitis B

1 any postpart

bull Eutogravecic 73

bull Fograverceps77

bull Cesagraverea68 p=089

RPM PP RCIU meconi apgarlt7 + immunoprofilaxis

no associat a TV

Hu Y chen J Wen J et al Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus BMC Pregnancy and Childbirth 2013 13119 Effect of delivery mode on maternal-infant transmission of Hepatitis B virus by immunoprophylaxis Chin Med J 20021151510-12

Transmissioacute partperinatal

Hepatitis B

Lactagravencia materna

Immunoprofilaxi + lactagravencia materna

bull No increment del risc de transmissioacute

bull No increment clivelles

Chen Z Chen J Wen J et al Breast feeding is not a risk factor for mother to child transmission of Hepatitis B virus Plos One 2013 8 E55303

Hepatitis B

Factors de Risc TV

bull HBe Ag HBeAg + 65-78 HBeAg - 9-23 bull VHB DNA viral load gt DNA VHB gt TV Cutt off 105-108 cogravepiesmL TV 9 gt 1x108 cogravepiesmL TV= 0 lt 1x108 cogravepiesmL

CV millor predictor independent HBeAg+

Wiseman E Fraser M Holden S et al Perinatal transmission of hepatitis B virus an Australian experience Med J Aust 2009190489-92

Hepatitis B

Lactagravencia materna

Immunoprofilaxi + lactagravencia materna

bull No increment del risc de transmissioacute

bull No increment clivelles

Chen Z Chen J Wen J et al Breast feeding is not a risk factor for mother to child transmission of Hepatitis B virus Plos One 2013 8 E55303

Hepatitis B

Factors de Risc TV

bull HBe Ag HBeAg + 65-78 HBeAg - 9-23 bull VHB DNA viral load gt DNA VHB gt TV Cutt off 105-108 cogravepiesmL TV 9 gt 1x108 cogravepiesmL TV= 0 lt 1x108 cogravepiesmL

CV millor predictor independent HBeAg+

Wiseman E Fraser M Holden S et al Perinatal transmission of hepatitis B virus an Australian experience Med J Aust 2009190489-92

Hepatitis B

Factors de Risc TV

bull HBe Ag HBeAg + 65-78 HBeAg - 9-23 bull VHB DNA viral load gt DNA VHB gt TV Cutt off 105-108 cogravepiesmL TV 9 gt 1x108 cogravepiesmL TV= 0 lt 1x108 cogravepiesmL

CV millor predictor independent HBeAg+

Wiseman E Fraser M Holden S et al Perinatal transmission of hepatitis B virus an Australian experience Med J Aust 2009190489-92

Hepatitis B

Factors de NO Risc TV

bull Genotip

bull Amenaccedila avortament i multiparitat

bull CV VHB + sang cordoacute srsquoassocia a part preterme perograve no a TV

bull Amniocentesis Biogravepsia corion no dades

Elefsiniotis I Tsoumakas K Papadakis M et al Importance of maternal and cord blood viremia in pregnant women with chronic hepatitis B virus infection Eur J Intern Med 2011 22182-6 Lopez M Coll O Chronic viral infections and invasive procedures risk of vertical transmission and current recomendations Fetal Diagn Ther 2010281-8

APP OR544 95 IC=115-2567

Hepatitis B

Immunoprofilaxis IGHB +- Vacuna VHB

bull IGHB nou nat TV OR 05 CI 95= 041-06 Pool donants VHB- immunes im immunitzacioacute immediata i perecedera

bull IGHB mare infectada VHB IGHB nou nat + IGHB mare 3er trimestre 100-200 UI im 28-32-36 w Disminucioacute CV i pas immunitat transplacentagraveria reduccioacute TV si indicat cagraverrega viral OR015 CI 007-03 HBsAg OR022 CI027-02

Shi Z Li X Ma L et al Hepatitis B Immunoglobulin injection in pregnancy to interrup hepatitis B virus mother-to-child transmission ndasha meta-analysis Int J Infect Dis 201014e622-e634

Hepatitis B

Immunoprofilaxis IGHB +- Vacuna VHB

bull Vacuna VHB Proteiumlnes virals purificades HBsAg (DNA recombinant) ndash no infecciosa

3 dosis (primera neacuteixer)

HBsAc

Vacuna RR028 CI 02-04

Vacuna sola proteccioacute gt 83

Chen D Hepatitis B vaccination The Key towards elimination and eradication of hepatitis B J Hepatol 2009 50805-16

Lee C Gong I Brok J et al Effect of Hepatitis B immunization in newborn infants of mothers positive for hepatitis B Surface antigen systematic review and meta-analysis BMJ 2006332328-36

bull IGHB + Vacuna VHB vs placebo

RR 008 CI 003-017

bull IGHB + Vacuna VHB vs Vacuna VHB

RR 054 CI 041-053

Hepatitis B

Fallo Immunoprofilaxis

Del Canho R Grosheide P Mazel J et al Ten-year neonatal hepatitis B vaccination program The Netherlands 1982-1992 protective efficacy and long term immunogenicity Vaccine 199715 1624-30

bull HBs Ag + o DNA VHB detectable 9-12 meses

nen ha rebut IGHB + vacuna

Transmissioacute intrauterina causa principal HBeAg + DNA VHB gt1x108 copiasmL

1-14

Meta anagravelisis Holanda (10 anys immunoprofilaxis) eficagravecia 100 DNA viral load lt1x107 copiasmL eficagravecia 68 DNA viral load gt1x107 copiasmL

Hepatitis B

Antivirals

bull Descens DNA VHB pas transplacentari fallo immunoprofilaxis

bull Tractament segur i no teratogegravenic Antivirals no autoritzats durant embaragraves

bull Inici final 2o trimestre o 3er trimestre finalitzada organogegravenesis major taxa TV VHB bull Indicacions DNA VHB gt1x10 6-7 cogravepiesmL (EASL)

European Association for the Study of the Liver EASL Clinical Practice Guidelines Management of chronic hepatitis B virus infection J Hepatol 2012 57167ndash185

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Immunoprofilaxis IGHB +- Vacuna VHB

bull IGHB nou nat TV OR 05 CI 95= 041-06 Pool donants VHB- immunes im immunitzacioacute immediata i perecedera

bull IGHB mare infectada VHB IGHB nou nat + IGHB mare 3er trimestre 100-200 UI im 28-32-36 w Disminucioacute CV i pas immunitat transplacentagraveria reduccioacute TV si indicat cagraverrega viral OR015 CI 007-03 HBsAg OR022 CI027-02

Shi Z Li X Ma L et al Hepatitis B Immunoglobulin injection in pregnancy to interrup hepatitis B virus mother-to-child transmission ndasha meta-analysis Int J Infect Dis 201014e622-e634

Hepatitis B

Immunoprofilaxis IGHB +- Vacuna VHB

bull Vacuna VHB Proteiumlnes virals purificades HBsAg (DNA recombinant) ndash no infecciosa

3 dosis (primera neacuteixer)

HBsAc

Vacuna RR028 CI 02-04

Vacuna sola proteccioacute gt 83

Chen D Hepatitis B vaccination The Key towards elimination and eradication of hepatitis B J Hepatol 2009 50805-16

Lee C Gong I Brok J et al Effect of Hepatitis B immunization in newborn infants of mothers positive for hepatitis B Surface antigen systematic review and meta-analysis BMJ 2006332328-36

bull IGHB + Vacuna VHB vs placebo

RR 008 CI 003-017

bull IGHB + Vacuna VHB vs Vacuna VHB

RR 054 CI 041-053

Hepatitis B

Fallo Immunoprofilaxis

Del Canho R Grosheide P Mazel J et al Ten-year neonatal hepatitis B vaccination program The Netherlands 1982-1992 protective efficacy and long term immunogenicity Vaccine 199715 1624-30

bull HBs Ag + o DNA VHB detectable 9-12 meses

nen ha rebut IGHB + vacuna

Transmissioacute intrauterina causa principal HBeAg + DNA VHB gt1x108 copiasmL

1-14

Meta anagravelisis Holanda (10 anys immunoprofilaxis) eficagravecia 100 DNA viral load lt1x107 copiasmL eficagravecia 68 DNA viral load gt1x107 copiasmL

Hepatitis B

Antivirals

bull Descens DNA VHB pas transplacentari fallo immunoprofilaxis

bull Tractament segur i no teratogegravenic Antivirals no autoritzats durant embaragraves

bull Inici final 2o trimestre o 3er trimestre finalitzada organogegravenesis major taxa TV VHB bull Indicacions DNA VHB gt1x10 6-7 cogravepiesmL (EASL)

European Association for the Study of the Liver EASL Clinical Practice Guidelines Management of chronic hepatitis B virus infection J Hepatol 2012 57167ndash185

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Immunoprofilaxis IGHB +- Vacuna VHB

bull Vacuna VHB Proteiumlnes virals purificades HBsAg (DNA recombinant) ndash no infecciosa

3 dosis (primera neacuteixer)

HBsAc

Vacuna RR028 CI 02-04

Vacuna sola proteccioacute gt 83

Chen D Hepatitis B vaccination The Key towards elimination and eradication of hepatitis B J Hepatol 2009 50805-16

Lee C Gong I Brok J et al Effect of Hepatitis B immunization in newborn infants of mothers positive for hepatitis B Surface antigen systematic review and meta-analysis BMJ 2006332328-36

bull IGHB + Vacuna VHB vs placebo

RR 008 CI 003-017

bull IGHB + Vacuna VHB vs Vacuna VHB

RR 054 CI 041-053

Hepatitis B

Fallo Immunoprofilaxis

Del Canho R Grosheide P Mazel J et al Ten-year neonatal hepatitis B vaccination program The Netherlands 1982-1992 protective efficacy and long term immunogenicity Vaccine 199715 1624-30

bull HBs Ag + o DNA VHB detectable 9-12 meses

nen ha rebut IGHB + vacuna

Transmissioacute intrauterina causa principal HBeAg + DNA VHB gt1x108 copiasmL

1-14

Meta anagravelisis Holanda (10 anys immunoprofilaxis) eficagravecia 100 DNA viral load lt1x107 copiasmL eficagravecia 68 DNA viral load gt1x107 copiasmL

Hepatitis B

Antivirals

bull Descens DNA VHB pas transplacentari fallo immunoprofilaxis

bull Tractament segur i no teratogegravenic Antivirals no autoritzats durant embaragraves

bull Inici final 2o trimestre o 3er trimestre finalitzada organogegravenesis major taxa TV VHB bull Indicacions DNA VHB gt1x10 6-7 cogravepiesmL (EASL)

European Association for the Study of the Liver EASL Clinical Practice Guidelines Management of chronic hepatitis B virus infection J Hepatol 2012 57167ndash185

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Fallo Immunoprofilaxis

Del Canho R Grosheide P Mazel J et al Ten-year neonatal hepatitis B vaccination program The Netherlands 1982-1992 protective efficacy and long term immunogenicity Vaccine 199715 1624-30

bull HBs Ag + o DNA VHB detectable 9-12 meses

nen ha rebut IGHB + vacuna

Transmissioacute intrauterina causa principal HBeAg + DNA VHB gt1x108 copiasmL

1-14

Meta anagravelisis Holanda (10 anys immunoprofilaxis) eficagravecia 100 DNA viral load lt1x107 copiasmL eficagravecia 68 DNA viral load gt1x107 copiasmL

Hepatitis B

Antivirals

bull Descens DNA VHB pas transplacentari fallo immunoprofilaxis

bull Tractament segur i no teratogegravenic Antivirals no autoritzats durant embaragraves

bull Inici final 2o trimestre o 3er trimestre finalitzada organogegravenesis major taxa TV VHB bull Indicacions DNA VHB gt1x10 6-7 cogravepiesmL (EASL)

European Association for the Study of the Liver EASL Clinical Practice Guidelines Management of chronic hepatitis B virus infection J Hepatol 2012 57167ndash185

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Antivirals

bull Descens DNA VHB pas transplacentari fallo immunoprofilaxis

bull Tractament segur i no teratogegravenic Antivirals no autoritzats durant embaragraves

bull Inici final 2o trimestre o 3er trimestre finalitzada organogegravenesis major taxa TV VHB bull Indicacions DNA VHB gt1x10 6-7 cogravepiesmL (EASL)

European Association for the Study of the Liver EASL Clinical Practice Guidelines Management of chronic hepatitis B virus infection J Hepatol 2012 57167ndash185

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Patton H and Tran TT Management of hepatitia B during pregnancy Nat Rev Gastroenterol Hepatol 2014

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

bull ITIAN inhibeix replicacioacute DNA VHB (97 disminucioacute en 2 setm)

bull 100 mgdia inici 28 setm fins 1 mes postpart

bull lt TV intrauacuteter 12-238 vs placebo

bull 9-12m 14-2 menys TV

HBsAg OR031 CI 015-063 plt001

DNA VHB OR02 CI 01-039 plt001

bull Segur pre i durant embaragraves (gt4000 gestants HIV

bull Alta taxa resistegravencies

24 despreacutes de 1 any de tractament

70 despreacutes de 4 anys

Shi Z Yang Y Ma L et al Lamivudina in late pregnancy to interrup in utero transmission of hepatitis B virus a systematic review and meta-analysis Obstet Gynecol 2010 116147-59

LAMIVUDINA

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

TELBIVUDINA

bull ITIAN inhibeix replicacioacute DNA VHB

bull 600 mgdia inici a las 28 setm fins 1 mes postpart

bull 9-12m menys TV

HBsAg RR011 CI 004-031

DNA VHB RR009 CI 004-022

bull FDA B

bull Taxa de resistegravencies

5 despreacutes de 1 any de tractament

11 despreacutes de 2 anys

Deng M Zhou X Gao S et al The effects of Telbivudina in late pregnancy to prevent intrauterine transmission of hepatitis B virus a systematic review and meta-analysis Virol J 2012 9185

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

TENOFOVIR

bull ITIAN inhibeix replicacioacute DNA VHB

bull 300 mgdia inici a les 28 setm fins 1 mes postpart bull Disminucioacute TV intrauacuteter

Reduccioacute DNA VHB 525 +-179 vs 887 +-045 log 10 cogravepiesmL plt001

bull FDA B

bull No resistegravencies (eleccioacute en no gestants)

Falten estudis de seguritat i eficagravecia (gt2000 gestants HIV)

lower leght and head circunference Z-score at 1 year ()

New York retrospectiu 9 pacients (HBeAg + DNA VHB + )

no TV

no efectes adversos ni malformacions

Pan C MI L Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B infection by highly viremic pregnant women a case series Dig Dis Sci 2012572423-9

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

ARV consideracions especials

bull ARV preembaragraves stop 1-2 trimestre

50 gt ALT x5 normal

no descompensacioacute hepagravetica

bull ARV lactagravencia materna NO TDF

TDF Llet materna TNF 003 dosis nounat TNF no absorbeix GI adult

concentracioacute simulada en plasma es extremadament baixa

bull ARV Cirrosis

Augment mortalitat complicacions

mare 18 vs 0 plt00001 EHE DPPNI HPP

fetus 52 vs 21 plt0001 PP RCIU

Tractament tot embaragraves

Kim H Choi J Park C et al Outcomes after discontinuing antiviral agents during pregnacy in chronic infection with hepatitis B virus J Clin Virol 201356299-305 Shi Z Wang H Screiber A et al Breastfeeding of newborns by mothers carrying hepatitis B virus a meta-analysis and systematic review Arch Pediatr Med 2011165-837-46

Benaboud S Pruvost A Coffie PA et al Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan Cote dIvoire in the ANRS 12109 TEmAA Study Step 2 Antimicrob Agents Chemother 201155(3)1315

Pan CQ Mi LJ Bunchorntavakul C et al Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women a case series Dig Dis Sci 2012 57(9) 2423ndash2429 Ehrhardt S Xie C Guo N et al Breastfeedint while taking lamiivudine or Tenofovir Disoproxil fumarate a revioew of the evidence CID 2014 131-4 European Association for the study of the Liver EASL clinical proactice gyuidelines management of chronic hepatitis B virus infection J Hepatol 201257 (1)167-185 Shaheen AA Myers RP The outcomes of pregnancy in patients with cirrhosis a populations-based study Liver Int 201030(2)275-283

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Tractament preembaragraves

DNA VHB indetectable preembaragraves

Hepatitis B virus DNA and RNA analyses in oocytes and embryos and virus particles containing HBsAgs HBV in oocytes and embryos suggests the possibility of vertical transmission of HBV via the germ line

Pan C Lee HM Antiviral Therapy for Chronic Hepatitis B in Pregnancy Semin Liver Dis 201333138ndash146 Nie R Jin L Zhang H et al Presence of hepatitis B virus in oocytes and embryosa risk of hepatitis B virus transmission during in vitro fertilization Fertil Steril 201195(5)1667-1671

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

Bzowej NH Optimal Management of the hepatitis B patient who desires pregnancy or is pregnant Curr Hepatitis Rep 20121182-89

Scre

en

ing

To

tes

les

emb

aras

sad

es (

grau

A)

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Hepatitis B

2007-2014 (ARV 2010) N=137 TV=0

635 primera visitagt24 setm 219 diagnogravestic embaragraves

18

1

3419

9

9

10

Blanca

Gitana

Asiagravetica

Negra

Aacuterab

Llatinoamerican

a

Europa Est

EgraveTNIA

0 50 100

NO

HIV

VHC

VHD

LUES

Coinfeccions

83

1

79 Desconeguda

Transfussioacute

Sexual

Vertical

Transmissioacute

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

bullNo 88 bullPP 15 bullRPM 1 bullCorioamnionitis 1

59

9

23

9

Eutocic

Instrumentat

Cesarea

NI

Lactagravencia Materna 5985

Hepatitis B

bullAmnios 19 sem 1 x10 8

18 sem + ph calota CV indetectable 1 amniodrenaje bullShunt pleural

bullPE 5 bullRCIU 3 bullMalformacioacuten fetal 3 bullDG 13 bullTORCH 1

Proves invasives Complicacions embaragraves

Tipus de part

Lactagravencia

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

visita infecc any gen

CV pretract

GOTGPT preTT

ARV Inic ARV

CV post GOTGPT post

part lactagravencia VHB nadoacute

profilaxis

1 22 VHB 2011 C 73x10 7 9248 TDF 26 11x10 5 4824 eutogravecic LA neg IgHB + vacuna x 3

2 34 VHB 2013 C 10 8 147 TDF 364

3 16 VHB 2011 C 10 8 3228 TDF 28 lt20 4234 Ces elec

LM neg IgHB + vacuna x 3

4 18 VHB 2012 C 11x10 7 5647 TDF 28 55x10 3 2918 Eutogravecic LA neg IgHB + vacuna x 3

5 19 VHB 2014 C 10 8 1611 TDF 32 99x 10 5 2012 Ces elec

LA neg IgHB + vacuna x 3

6 34 VHB+VIH 2008 FTC TDF + LPV

35 Ces VIH

LA neg IgHB + vacuna x 3

7 10 VIH+VHB +VHC

2010 ATZ + RTV + RAL

Previ gestacioacute

lt20 127175 Eutoacutecic LA neg IgHB + vacuna x 3

8 21 VIH+VHB 2010 LPVr+ NVP+ TDF

Previo gestacioacute

1180 2620 Ces parto

LA neg IgHB + vacuna x 3

9 12 VIH+VHB 2014 FTC TDF +RTVDRV

Previ gestacioacute

lt20 4250 Eutoacutecic LA neg IgHB + vacuna x 3

10 8 VIH+VHB 2012 FTC TDF + RTV DRV

Previ gestacioacute

lt20 158

Embarassades VHB amb ARV HVH 2007-2014

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

137

mares

122 nens Vacuna + IgHB

105 nens 2 vacuna

86 nens 3 vacuna

60 nens Sans als 9 mesos

19nens No informacioacute

17nens No informacioacute

15 nens No informacioacute

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Dra Anna Suy

Coordinadora Urgegravencies Ginecologravegiques i Obstegravetriques

Vall drsquoHebron

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Streptococcus agalactiae

Pautes actuals de prevencioacute de la transmissioacute mare-fill

Ohlsson A Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database of Systematic Reviews 2014

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Screening universal 35-37 setmanes gestacioacute

Profilaxis GBS intrapart NO profilaxis GBS intrapart

GBS cultiu + Cultiu SBG negatiu

Fill previ segravepsia GBS GBS + en anterior gestacioacute

GBS bacteriuacuteria en gestacioacute actual

Bacteriuacuteria GBS en anterior gestacioacute

Cultiu GBS desconegut al part + 1 dels seguumlents bull lt37 setmanes bull RPM gt18 h bull Tge380ordmC bull PCR SBG + intrapart

Cesagraveria electiva amb membranes integres

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Streptococcus agalactiae

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Part prematur

No

Prendre cultiu vagino-rectal EGB

Iniciar PAI si es preveu inci de part imminent

Srsquo inicia realment el part

Iniciar o continuar

PAI fins part Parar PAI

Si

Iniciar PAI quan srsquoinici el part

Resultat cultiu EGB

Positiu Negatiu No disponible al inici del part i es lt37 setmanes

No PAI

Repetir el cultiu vagino-rectal 35-37 setmanes

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

NO

Cultiu EGB vagino-rectal +

iniciar antibiogravetics per lategravencia io PAI EGB

Srsquoinicia realment el part

Continuar antibiogravetics

fins part

Seguir antibioacutetics segons

protocol de lategravencia o

seguir antibioacutetics 48 hores si srsquoestaacuten

aplicant per PAI

SI

Obtenir resultat del cultiu EGB

Positiu Negatiu

No disponible lrsquoinici del part

Administrar PAI al

inici real del part

No PAI quan inici real del part

Repetir el cultiu vagino-rectal 35-37 setm

RPM

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

almiddotlegravergica a penicilmiddotlina

Penicilina G iv 5 milions UI

(dosis inicial) Seguida de 25 a 3

milions cada 4 h fins part

o

Ampicilina 2g iv (dosis incial)

seguida de 1g cada 4h fins part

EGB sensible a clindamicina i

eritromicina

Vancomicina iv 1g cada

12 h fins part

Clindamicina 900 mg iv 8 h

Fins part

Siacute

No Siacute

No o

desconocido

Tractament antibiogravetic recomanat

Pacient ha patit despreacutes de prendre

penicilina o cefalosporines

bull anafilaxia

bull angioedema

bull distress respiratori

bull urticaria

Siacute No

Cefazolina 2g iv seguit de 1 g8h

fins part

Centers for Disease Control and Prevention Prevention of Perinatal Group B Streptococcal Disease MMWR 201059(10)1-10)

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

Turrentine M Intrapartum antibiotic prophylaxis for group B Streptococcus has the time come to wait more than 4 hours Am J Obstet Gynecol 2014715-17 Konikkara KP et al Detection of Group B Streptococcus in pregnant women Journal of Clinical and Diagnostic Reserch 20148(2)47-49 Chen VL Avci FY Kasper DL A maternal vaccine against Group B Streptococcus Past present and future Vaccine 201331(04)D13-D19

Streptococcus agalactiae

Temps de profilaxis ge 4 hores 2 hores GBS vaginal colony counts decrease by 5-fold 4 hores GBS vaginal colony counts decrease by 50-fold menor risc infeccioacute neonatal si induccioacute immediata despreacutes RPM OR 029 95 008-105 NS

Utilitat PCR

Vacuna EGB Ac tipus III CPS Ag confereixen proteccioacute per early and late SGB sepsis

EGB consideracions especials

asuyvhebronnet

asuyvhebronnet