2. Avoid hepatitis E−endemic areas
Ideally, our patients should avoid travel to areas of the world where hepatitis E is endemic. If travel cannot be avoided, the patient should receive the new hepatitis E vaccine. This vaccine is administered in a 3-dose series; in clinical trials, it has had an efficacy of 85% to 90%.2
If a patient acquires hepatitis E infection, she should receive aggressive supportive care, with hospitalization strongly considered because of the increased risk for hepatic failure.
The clinical manifestations of hepatitis Eare very similar to those of hepatitis A: fever, malaise, anorexia, nausea, pain and tenderness in the right upper quadrant, jaundice, darkened urine, and clay-colored stools. Laboratory abnormalities in affected patients include elevated transaminase enzymes, elevated bilirubin, positive immunoglobulin M antibody against hepatitis E virus, a fourfold increase in a prior immunoglobulin G antibody titer against hepatitis E virus, and a positive test for hepatitis E RNA.2
3. Treat patients with HSV infection to avoid an outbreak during delivery
Pregnant women who develop primary or recurrent HSV infection should be treated promptly with therapeutic doses of acyclovir or valacyclovir. Patients with frequent recurrences should receive daily anti-HSV prophylaxis throughout pregnancy. Other patients should be treated prophylactically from week 36 until delivery.
4. Recommend malaria prophylaxis when appropriate
If your pregnant patient is traveling to an area of the world where malaria is endemic, she should receive appropriate prophylaxis, especially against P falciparum.
5. Vaccinate during pregnancy and promptly treat developed infections
All infections in pregnant women should be treated in a timely manner with appropriate antibiotics. Moreover, we should make a firm effort to provide all pregnant women with the following vaccinations: influenza, Tdap, and hepatitis B (if susceptible). Select patients also should receive pneumococcal vaccine (those who are immunosuppressed; have chronic medical illnessess, particulary cardiopulmonary disease; or have had a splenectomy).
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