|Title:||Antenatal Testing for Sexually Transmissible Infections and Blood-Borne Viruses|
|Document ID:||Operational Directive OD 0064/07|
|Date of issue:||Friday, 3 August 2007|
|Status:||NO LONGER APPLICABLE|
|Description:||The Operational Directive provides information about antenatal testing for sexually transmissible infection and blood -borne viruses and recommends appropriate testing for pregnant women as part of their antenatal care.|
|Applicable to:||General Practitioners; Antenatal Clinical Service Providers|
|Period of effect:||from 1 July 2007 to 1 July 2009|
|Authorised by:||John Leaf, ACTING DIRECTOR GENERAL, DEPARTMENT OF HEALTH, 03-Aug-2007|
|Print version:||View print version|
Antenatal Testing for Sexually Transmissible Infections and Blood-Borne VirusesOVERVIEW
The purpose of this Operational Directive is to provide information about antenatal testing for sexually transmissible infections (STIs) and blood-borne viruses (BBVs) and to recommend appropriate testing for pregnant women as part of their antenatal care. The recommendations are in line with the Department of Health Women and Newborn Health Service’s updated Antenatal Shared Care Guidelines for General Practitioners and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ statement: Antenatal screening tests (RANZCOG 2006).
Tests for pregnant women at their first antenatal visit:
Tests at subsequent antenatal visits
Women, who are believed to be at high risk of acquiring syphilis, hepatitis B, hepatitis C, HIV and chlamydia or who have put themselves at risk of infection since their first test, should be retested in the third trimester (28-36 weeks). In addition:
Additional tests for women living in STI-endemic areas
All women living in STI endemic regions of WA, i.e. the Kimberley, Pilbara and Goldfields, should be offered the following additional tests:
Women who present for the first time either late in pregnancy or during labour and who have not received any antenatal care may be at increased risk of STI/BBV infection. Testing may need to be performed urgently in these situations to ensure that appropriate therapy can be commenced to benefit both the mother and baby.
See Appendix 1: “Recommended screening tests” for more information.
Sexually transmissible infections (STIs) and blood-borne viruses (BBVs) in pregnancy are of considerable importance. Not only may they cause maternal morbidity, they may also have severe effects on a foetus or child including spontaneous abortion, foetal death, premature labour, low birth weight and neonatal infection.
For some healthy young women of child-bearing age, the period of antenatal care may be the only contact they have with the health system. Women may be unaware of their risks for infection with STIs and BBVs and the infections are often asymptomatic. All pregnant women and their sexual partners should be asked about STIs and BBVs, counselled about the possibility of perinatal infections, and ensured access to treatment, if needed. As with any test or procedure, these investigations should only be undertaken with the informed consent of the patient after adequate and appropriate pre-test discussion as to the implications, limitations and consequences of such investigations.
Antenatal testing for STIs and BBVs provides an opportunity for:
1.1 Risk Assessment
For STIs and BBVs, a comprehensive assessment of risk should be undertaken at the first antenatal visit to enable recommendations regarding appropriate screening to be made based on risk. Sufficient information about risk activities is essential to enable women to make informed decisions regarding testing.
The following factors may be considered as high risk:
In assessing risk, consideration should also be given to the local epidemiology of STIs/BBVs.
2. PROCEDURES FOR ANTENATAL STI/BBV TESTING
2.1 Role of health care professionals providing antenatal care
General practitioner care
When a mother attends a general practitioner (GP) for antenatal care, the GP should undertake STI and BBV screening tests at the first antenatal visit.
Antenatal clinic care
When a mother attends an antenatal clinic, check whether appropriate tests have already been carried out by a GP and that appropriate action has been taken based upon test results. If any tests have not been done, they will need to be carried out at the clinic.
2.2 Informed consent and confidentiality
All pregnant women should be informed that STI/BBV testing is available. Pregnant women should only be tested after they have voluntarily agreed to such testing. To assist pregnant women to make a decision regarding testing they should be provided with sufficient information to allow them to give informed consent.
In addition to screening, women who engage in high risk behaviours should be offered:
Discrimination is a real threat to persons with an STI or BBV. In order to have voluntary disclosure regarding risk behaviours, individuals must be assured that the information they provide is necessary to determine their risk of STI/BBV infection and that confidentiality will be maintained. Patients attending obstetric services should be informed that policies and procedures to safeguard confidentiality are in place. 2.3 Clinical management and contact tracing Women diagnosed with an STI or BBV should be provided with adequate information on the relevant STI or BBV, the implications of the STI or BBV for them and their foetus/neonate, and treatment options. Expert advice on the management of an STI, HIV/AIDS or hepatitis B or C is available from specialist services (Appendix 2).
Medical practitioners are required to provide the following information to persons with an STI or BBV including HIV: · means of minimising the risk of infecting other people · notification requirements; and · the need to inform sexual and injecting partners as appropriate of their infectious status.
Contact tracing is an essential element in the overall management of a person with an STI or BBV. For detailed information on contact tracing, reference should be made to the Department of Health’s Guidelines for Managing Sexually Transmitted Infections 2006 and the Australian Government Department of Health and Ageing’s Australasian Contact Tracing Manual.
Contact tracing is particularly desirable for STIs and BBVs where there is a reasonable chance of serious consequences, and where contacts will benefit from prophylaxis, treatment or counselling. Population Health Units and specialist sexual health services can assist with contact tracing.
This circular last updated: Friday, 3 August 2007 at 4:26pm