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Gynécologie Obstétrique & Fertilité
Volume 33, n° 6
pages 423-428 (juin 2005)
Doi : 10.1016/j.gyobfe.2005.04.023
Received : 29 Mars 2005 ;  accepted : 27 April 2005
Sérologie des hépatites B et C : interprétation et conséquences pratiques chez la femme
Hepatitis B and C virological tests: interpretation and practical results in women
 

P.-H. Bernard
Service d'hépato-gastroentérologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France 

Résumé

L'infection chronique virale B ou C peut être responsable d'une évolution vers la cirrhose et le carcinome hépatocellulaire. Chez la femme, elle pose également le problème de transmission de l'infection au conjoint et à l'enfant lors de l'accouchement. Pour le virus de l'hépatite C, les modes de contamination principaux sont les antécédents de transfusion avant 1991 et l'utilisation de substances intraveineuses. Le risque de transmission foetomaternelle est rare (5 %) : en dehors de l'éradication virale avant la grossesse, il n'y a pas de mesure préventive à proposer. La grossesse n'est pas contre-indiquée. La contamination sexuelle dans un couple stable est exceptionnelle (<1 %). Pour le virus de l'hépatite B, le mode de contamination prédominant est sexuel dans les pays de faible endémie et périnatal dans les pays de moyenne à forte endémie. Le risque de contamination foetomaternelle est élevé de 20 à 90 % en fonction de la charge virale B. Le risque de contamination peut être prévenu par la vaccination, fortement conseillée dans les groupes à risques. La vaccination universelle des nourrissons est vivement recommandée.

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Abstract

Chronic Hepatitis C or B infection can lead to liver cirrhosis and hepatocellular carcinoma. In women, these viral infections can be responsible for transmission to the spouse and to the child during delivery. Concerning the hepatitis C virus, the factors most strongly associated with infection are injection-drug use and blood transfusion before 1991. The risk of mother-to-infant transmission of hepatitis C virus is uncommon (5 per cent): except for the viral eradication before pregnancy, there is no preventive measure to propose. Pregnancy is not contra-indicated. Hepatitis C virus transmission by sexual contact in steady monogamous partnerships is low (< 1 per cent). In most developed parts of the world where the prevalence of chronic hepatitis B infection is low, most infections occur among high-risk adult populations including injection drug users and multiple heterosexual partners. On the contrary, in high prevalence areas, infection occurs during either the perinatal period or early in childhood. The risk of maternal-infant contamination is high, from 20 to 90 per cent according to the viral load. Vaccination prevents risk of infection and is strongly advised to persons at high risk of infection. Universal vaccination of infants is highly recommended.

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Mots clés : Virus de l'hépatite C, Virus de l'hépatite B, Dépistage, Grossesse, Vaccination

Keywords : Hepatitis B virus, Hepatitis C virus, Screening, Pregnancy, Vaccination




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