The full liberalization of the second child birth, some women in their early and mid-40s, follicular activity has been less than in the year of the first child, the conception period may be prolonged; rare comorbidities at the end of pregnancy may occur. For chronic hepatitis B virus infection and similar age of women without hepatitis B infection is not significantly different, this article just want to remind: rational choice of antiviral drugs, concerned about the possible rebound of the disease after delivery. My sister, 24 years old, is married with children. It is presumed to be a mother-to-child vertical infection, because I am also a major triple yang. the child was born in February 2014, before the full month, she was hospitalized for jaundice, both transaminases were more than 2,000 U/L, total bilirubin was more than 300 μmol/ml, and prolongation of the prothrombinogen time (PT), and the diagnosis of acute liver failure occurring with chronic hepatitis B virus carriage (“slow plus urgent “), glycyrrhizic acid to protect the liver and reduce enzymes, then use tibivudine antiviral, hospitalized for more than half a month and discharged. Taking this drug for 8 months check, Abbott reagent results: surface antigen 0.032iu/ml (reference value 0-0.05), surface antibody <2.0 mIU/ml (reference value 0-10), E antigen 1.07 S/CO (reference value ≥1.0 positive), E antibody is positive, and core antibody is positive. After 10 months of taking Sulbivolol, I consulted you and you replied, "This was preceded by a strong immune rebound after delivery and an acute exacerbation of the disease while the virus and its antigens were cleared. It is possible to recover from this or to gradually reverse the positivity. You should check your liver function and the virus every month to see how it is progressing and take precautions in advance". Now taking entecavir for 11 months, the vaccine has been finished, the last three retests of Hepatitis B Pentathlon Abbott quantitative results: surface antigen and E antigen are all negative, the surface antibody is more than 700 mIU / ml. 2015 Hepatitis B guideline did not mention this part of the patient, is very confusing, and came to consult with you:My sister this situation can stop the drug? Does she need to have a liver puncture before stopping the medication? How to review after stopping the medication? [Case Study] Why is it that the morbidity of older women may increase and their condition may be more serious after delivery? The fertilized egg from the union of the father's sperm and the mother's egg develops into a fetus, half of which is genetically inherited from the father, and this half is equivalent to a xenotransplantation, so why does it not reject the fetus or cause miscarriage? This is due to the fact that the immune clearance (rejection) of the pregnant woman is suppressed by evolution from animals. However, after delivery the immune response is restored and immune clearance may enter, so hepatitis develops and acute liver failure is the result of a strong immune clearance response. Pregnancy does not increase the burden on the liver, and immune clearance is suppressed, so the incidence of hepatitis in pregnant women is not high. The onset of the disease increases in the six months after delivery and can be called post-delivery hepatitis. Immune tolerance disappears with age, and older women are more likely to enter the immune-clearance phase and may be more severely ill. How does an acute exacerbation of the disease develop? How to block its progression to liver failure? Acute exacerbation of chronic infection can be divided into three stages: (1) Acute exacerbation: the onset of the disease is acute, with lethargy and anorexia, which may also resemble a cold. Transaminases soar, exceeding 1000 U/L within a few days; (2) Pre-liver failure: extreme lethargy, loss of appetite, even vomiting. The whites of the eyes and the skin are yellowish, the urine is like strong tea, and the total bilirubin exceeds 80 μmol/ml; (3) Acute liver failure: the symptoms are more severe, and the prolongation of the prothrombin time by 5 seconds is taken as the gold standard for diagnosis. The immune clearance response is strong, the condition deteriorates rapidly, and it may be difficult to distinguish between the three stages. After delivery, tiredness, loss of appetite, it is difficult to explain the hard work of taking care of the baby, urgent liver function tests, transaminases increased more than 500U / L, emergency hospitalization hanging bottle liver protection to reduce enzymes, and began to take entecavir antiviral therapy. What are the consequences of slow plus acute? Acute exacerbations of chronic infections are characterized by rapidly developing severe inflammation, massive hepatocellular necrosis, and aggressive disease. The liver takes a severe beating, and with prompt resuscitation, including aggressive hepatic and enzyme lowering and good antiviral therapy, many patients may be able to return to their pre-exposure status quo. Immune clearance is a double-edged sword, a large number of hepatocyte necrosis, the virus also died with the virus, at the same time, the virus and its antigens are cleared, the original only chronic carriers of a small number of patients, may be the end of the carries, the spontaneous production of, or through the Hepatitis B vaccine to produce surface antibodies, and from then on to be cured. As long as the surface antibody level is high, the medication can be stopped cautiously. Thereafter, the surface antibody is checked every 3 months and falls below 100mIU/ml, the hepatitis B vaccine can be injected, and the antibody level must be maintained for 3 to 5 years in order to be assured. After most patients' inflammation is relieved, a large number of hepatocytes are newborn, which is equivalent to building a lot of new houses, and the virus remaining after the robbery has space for replication, which can be replicated rapidly and in large quantities, so the virus and antigens rebound and hepatitis relapse. Active antiviral treatment can avoid or reduce the condition of hepatitis.