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23. Obstetrics

Please find information regarding the care of pregnant women and their communicable disease screening requirements in the subsections below.

Hepatitis B - Management of women identified through antenatal screening

Obstetrics: Women presenting in labour

Obstetrics: Late bookers (24+/40)

Chickenpox/shingles exposure in pregnant patients

Please note the antenatal clinic TrakCare order set for midwives: 

"ANC - Set"

Syphilis Serology Screen (EDTA blood - BBV) WoSS Virology Centre, GRI
Hep B Screen ( HBsAg ) (EDTA blood - BBV) WoSS Virology Centre, GRI
HIV Screen (EDTA blood - BBV) WoSS Virology Centre, GRI

Search on TrakCare page "New Request" => Add "ANC" into "Item" and click on the eye glass

Zika virus: sample testing advice webpage has been updated

Highlights:

•    Zika virus testing is provided ONLY for individuals who have or have had symptoms, NOT for asymptomatic individuals, including asymptomatic pregnant women; this is consistent with WHO guidelines
•    Zika virus serology is now provided for individuals with previous Zika–like symptoms, as well as those with current symptoms
•    Clinicians are advised to consider the possibility of sexually acquired infection in the symptomatic partners of travellers to Zika-affected countries
•    The updated guidance includes a table showing what standard samples to send to RIPL for Zika virus testing
•    RIPL must be contacted for discussion before special (i.e. non-standard) samples such as semen or amniotic fluid are submitted for testing
•    Patients should never be directed to call RIPL to discuss Zika virus testing 

The RCOG algorithm and guidance for the management of pregnant women exposed to Zika virus has also been updated to take account of Zika virus serology test results.  

Highlights:

•    Pregnant cases diagnosed with Zika virus by serological testing are managed in exactly the same way as those diagnosed by PCR, i.e. they should be referred to Fetal Medicine Unit
•    Symptomatic pregnant returned travellers with negative Zika virus antibody results on serum collected 4 or more weeks after the last possible travel-associated or sexual exposure do not require further extra fetal ultrasound follow-up. That is, these women for whom 4-weekly fetal ultrasound scans were previously advised, can return to normal pregnancy care, unless there are additional concerns
•    Note that for asymptomatic pregnant returned travellers, fetal USS at specific time points is now recommended instead of consideration of 4 weekly fetal USS; this is consistent with WHO guidelines

Please contact the WoSSVC with any question you have regarding Zika virus (tel: 38722 / 0141 201 38722)

Rubella (German measles) susceptibility (IgG) screening in pregnancy ended on the 1st of June 2016. 

The decision to stop screening follows a review of evidence by the UK National Screening Committee (UK NSC) in 2003 and 2012.

On both occasions the Committee found that screening for rubella susceptibility during pregnancy no longer met the criteria for a screening programme and should be discontinued because:

  • rubella infection levels in the UK are so low they are defined as eliminated by the World Health Organization
  • rubella infection in pregnancy is very rare
  • being fully immunised with the measles, mumps and rubella (MMR) vaccine before becoming pregnant is more effective in protecting women against rubella in pregnancy
  • the screening test used can potentially give inaccurate results and cause unnecessary stress among women

The decision to end screening for rubella susceptibility in pregnancy has been made possible by the high levels of vaccination rates achieved through the MMR immunisation programme.

Source: Public Health England

Rubella IgG is no longer be available to order on TrakCare. PLEASE USE ‘ANC – SET’ FOR ANTENATAL SCREENING TESTS, THIS ORDER SET HAS BEEN UPDATED.

If you have any questions please don't hesitate to contact the virus laboratory on 58721 / 58722.

Further resources:

Health Protection Scotland: Rubella