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Case Series
Differing presentations of hepatitis C in pregnancy: A case report series supporting universal screening for hepatitis C virus in pregnancy
1 Obstetrics and Gynecology Resident, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
2 Medical Student, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
3 Obstetrician/Gynecologist Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey/ Hackensack Meridian Health Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
Address correspondence to:
Daniela Gomez
Clinical Academic Building, 125 Paterson St - Rm 2133, New Brunswick, New Jersey 08901,
USA
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Article ID: 101032Z01DG2019
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Gomez D, Kumar S, Misra N. Differing presentations of hepatitis C in pregnancy: A case report series supporting universal screening for hepatitis C virus in pregnancy. Int J Case Rep Images 2019;10:101032Z01DG2019.ABSTRACT
Introduction: The prevalence of Hepatitis C virus (HCV) infection in women of childbearing age is on the rise. Of people infected, 50–85% develop chronic hepatitis C. Chronic HCV infection is significant because it puts the mother and fetus at risk for well described complications. Conversely, pregnancy alters the natural progression of chronic HCV potentially impacting the long-term health of the mother. Differing presentations of HCV make the identification of patients with HCV infection challenging. Currently, HCV testing for pregnant women is only recommended by the Society for Maternal Fetal Medicine (SMFM) and the American College of Obstetrics and Gynecology (ACOG) for women with preexisting risk factors.
Case Series: In this case series of three obstetric patients with HCV we would like to highlight the varied range of clinical presentations of HCV in pregnancy. The first patient had a known HCV infection prior to pregnancy. Liver function tests and a viral load collected at her first prenatal visit were consistent with viral clearance and she went on to have an uneventful pregnancy. Patient two developed intrahepatic cholestasis of pregnancy (ICP), a well-described complication of chronic HCV infection. Finally, patient three developed transaminitis and a decrease in her viral load: the opposite of expected findings.
Conclusion: This case series illustrates classic and unusual presentations of HCV in pregnancy. Heterogeneity of presentations with inconsistent presence of risk factors on presentation makes predicting who needs screening difficult. Given the availability of new treatments and the serious morbidity chronic hepatitis can inflict on both the mother and baby perhaps universal HCV screening in pregnancy should be reconsidered.
Keywords: Hepatitis C virus, Hepatitis C virus screening, Intrahepatic cholestasis of pregnancy, Pregnancy
SUPPORTING INFORMATION
Author Contributions
Daniela Gomez - Analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sunjay Kumar - Acquisition of data, Drafting the article, Final approval of the version to be published
Neeti Misra - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Source of SupportNone
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Daniela Gomez et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
