Pregnant women

Overview

  • STIs and blood borne viruses (BBVs) in pregnancy have been associated with significant maternal and foetal morbidity and mortality, including spontaneous abortion, foetal death, premature labour, low birth weight and neonatal infection.
  • Women may be unaware of their risks for infection.
  • Many STIs and BBVs are asymptomatic.
  • Antenatal STI and BBV testing offers the opportunity for early detection; prompt and appropriate management; prevention or reduction of adverse outcomes for the foetus or neonate; prevention of long term sequelae in the mother; informed antenatal care; patient education contact tracing.

Testing advice

InfectionConsideration

Hepatitis B

 

If not high-risk, the testing guidelines  recommend HBsAg testing only, with further testing with HBeAg and HBV DNA if HBsAg positive.
Consider vaccination post-partum if not immune.
If HBsAg positive, refer to specialist for review for consideration of treatment during third trimester, to prevent vertical transmission. Discuss need for the infant to receive hepatitis B immunoglobulin (HBIG) and vaccination at birth, to prevent transmission.

HIV Testing should be opt-out to ensure all women have access to HIV testing in pregnancy as a routine, however informed consent must be confirmed before testing.
Repeat test if patient exposed within previous 12 weeks (window period).
 Syphilis If clinical suspicion of syphilis, refer to the syphilis  guideline.
Chlamydia Consider
self-collection of samples for testing.

Treatment during pregnancy is recommended.

HBsAg – Hepatitis B surface antigen
HBeAg – Hepatitis B e antigen

Specimen collection

Clinician collected
Self-collection 

Clinical indicators for testing

Follow up

If test results are positive, refer to STI management section for advice on:

Test of cure (TOC)

In the event of a positive test result for syphilis or chlamydia, TOC should be considered following treatment. Contact tracing for all sexual partners is essential.

Retesting

Where continued risk is identified during pregnancy, consider retesting prior to delivery (about 36 weeks).

 

Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Vaccinate for hepatitis B postnatally
  • Discuss vaccination for hepatitis A postnatally
  • Discuss and activate reminders for regular testing according to risk, especially if their behaviours indicate the need for more frequent testing.

Auditable outcomes

  • 90% of pregnant women <30years have antenatal screening for chlamydia and gonorrhoea.
  • 100% of pregnant women tested for HIV and hepatitis B.
Last Updated: Wednesday, 26 November 2014