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are to be offered screening, priority being given to HIV and hepatitis B, and presumptive action is taken on a preliminary positive result
until such time as the result is confirmed. If an HIV test result will not be available in time, appropriate preventive measures should be offered. Use
of rapid test devices may be appropriate in this context.
Screening is only performed with documented consent, though this does not require a signature from the patient and the usual standards of confidentiality apply.
Screening for rubella antibodies
Congenital rubella syndrome was first described in 1941.
If the rubella virus is contracted during the first 8 weeks of pregnancy there is an 80% risk of malformations, microcephaly, and severe learning difficulties.
If the virus is contracted after 9 weeks of gestation there is a 20% risk of deafness and brain damage. Handicap is rare after the 16th week.
In order to prevent congenital rubella syndrome all children are offered protection from the virus with the measles, mumps, rubella (MMR) vaccine.
Women are screened during early pregnancy, usually at the time of the other routine blood tests, to record their immune status.
All non-immune women, and women with an antibody titre <10IU are recommended a further vaccine dose in the early postnatal period.
If a pregnant woman reports recent contact with an infected individual her immune status is confirmed. A titre >10IU suggests immunity.
If the titre is <10IU the test is repeated 2–3 weeks later. A fourfold increase in the titre suggests a recent infection.
If a woman presents more than 10–14 days after exposure a high IgM titre indicates viraemia in the last 4 weeks.
If infected in early pregnancy with a high risk of abnormality, termination of pregnancy would be offered.
1 Department of Health (2003). Screening for infectious diseases in pregnancy: Standards to support the UK Antenatal Screening Programme. Available at: M www.dh.gov.uk (accessed 2.4.10).
CHAPTER 4 Antenatal care
58
Screening for syphilis
Syphilis can seriously complicate pregnancy and result in spontaneous abor- tion (commonly at around 18–20 weeks’ gestation), stillbirth, intrauterine growth restriction, and perinatal death.
Antenatal screening for syphilis is well established, forming part of the routine screening of all pregnant women during the first or early second trimester.
As the prevalence of this infection is very low, continuation of the screening programme has recently been questioned, notably by Kiss et al . 1 whose survey of the prevalence in Austria seemed to suggest no economic benefit from universal antenatal screening.
Connor et al . 2 carried out an epidemiological survey in the UK which suggested that targeting the screening to at-risk groups or stopping the screening programme would save relatively little money, and recommended that the current universal antenatal screening for syphilis should continue.
Women who are at risk will be retested in the late second to early third trimester, as infection acquired during pregnancy still poses a
significant risk to the fetus.
Women who screen positive for the Venereal Disease Research Laboratory (VDRL) test will have this result confirmed by retesting with a Treponema -specific assay ( Treponema pallidum
haemagglutination test, TPHA test) and will be treated with antibiotics such as amoxycillin.
Kiss H, Widhalm A, Geusau A, Husslein P (2004). Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis. Eur J Obstet Gynecol Reprod Biol 112 (1): 24–8.
Connor N, Roberts J, Nicoll A (2000). Strategic options for antenatal screening for syphilis in the United Kingdom: a cost effectiveness analysis. J Med Screen 7 (1): 7–13.
HIV SCREENING
59
HIV screening
Pregnant women should be offered screening for HIV infection early in antenatal care because appropriate antenatal interventions can reduce mother-to-child transmission of HIV infection. A
until such time as the result is confirmed. If an HIV test result will not be available in time, appropriate preventive measures should be offered. Use
of rapid test devices may be appropriate in this context.
Screening is only performed with documented consent, though this does not require a signature from the patient and the usual standards of confidentiality apply.
Screening for rubella antibodies
Congenital rubella syndrome was first described in 1941.
If the rubella virus is contracted during the first 8 weeks of pregnancy there is an 80% risk of malformations, microcephaly, and severe learning difficulties.
If the virus is contracted after 9 weeks of gestation there is a 20% risk of deafness and brain damage. Handicap is rare after the 16th week.
In order to prevent congenital rubella syndrome all children are offered protection from the virus with the measles, mumps, rubella (MMR) vaccine.
Women are screened during early pregnancy, usually at the time of the other routine blood tests, to record their immune status.
All non-immune women, and women with an antibody titre <10IU are recommended a further vaccine dose in the early postnatal period.
If a pregnant woman reports recent contact with an infected individual her immune status is confirmed. A titre >10IU suggests immunity.
If the titre is <10IU the test is repeated 2–3 weeks later. A fourfold increase in the titre suggests a recent infection.
If a woman presents more than 10–14 days after exposure a high IgM titre indicates viraemia in the last 4 weeks.
If infected in early pregnancy with a high risk of abnormality, termination of pregnancy would be offered.
1 Department of Health (2003). Screening for infectious diseases in pregnancy: Standards to support the UK Antenatal Screening Programme. Available at: M www.dh.gov.uk (accessed 2.4.10).
CHAPTER 4 Antenatal care
58
Screening for syphilis
Syphilis can seriously complicate pregnancy and result in spontaneous abor- tion (commonly at around 18–20 weeks’ gestation), stillbirth, intrauterine growth restriction, and perinatal death.
Antenatal screening for syphilis is well established, forming part of the routine screening of all pregnant women during the first or early second trimester.
As the prevalence of this infection is very low, continuation of the screening programme has recently been questioned, notably by Kiss et al . 1 whose survey of the prevalence in Austria seemed to suggest no economic benefit from universal antenatal screening.
Connor et al . 2 carried out an epidemiological survey in the UK which suggested that targeting the screening to at-risk groups or stopping the screening programme would save relatively little money, and recommended that the current universal antenatal screening for syphilis should continue.
Women who are at risk will be retested in the late second to early third trimester, as infection acquired during pregnancy still poses a
significant risk to the fetus.
Women who screen positive for the Venereal Disease Research Laboratory (VDRL) test will have this result confirmed by retesting with a Treponema -specific assay ( Treponema pallidum
haemagglutination test, TPHA test) and will be treated with antibiotics such as amoxycillin.
Kiss H, Widhalm A, Geusau A, Husslein P (2004). Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis. Eur J Obstet Gynecol Reprod Biol 112 (1): 24–8.
Connor N, Roberts J, Nicoll A (2000). Strategic options for antenatal screening for syphilis in the United Kingdom: a cost effectiveness analysis. J Med Screen 7 (1): 7–13.
HIV SCREENING
59
HIV screening
Pregnant women should be offered screening for HIV infection early in antenatal care because appropriate antenatal interventions can reduce mother-to-child transmission of HIV infection. A
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