Guidance

Infectious diseases in pregnancy screening pathway requirements specification

Published 21 June 2021

Applies to England

© Crown copyright 2021

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This publication is available at https://www.gov.uk/government/publications/infectious-diseases-in-pregnancy-screening-pathway-requirements-specification/infectious-diseases-in-pregnancy-screening-pathway-requirements-specification

This document provides an overview of the NHS infectious diseases in pregnancy screening (IDPS) programme by describing what should happen at each stage of the pathway. It should be read alongside other guidance on the NHS IDPS programme, including:

Please also read the general information relevant to all the NHS screening programme pathways.

Screening for HIV, hepatitis B and syphilis

The purpose of screening is to enable early detection and treatment of HIV (human immunodeficiency virus), hepatitis B or syphilis in pregnant women and significantly reduce the chance of vertical transmission of infection.

The NHS offers and recommends women to have screening tests for infectious diseases in every pregnancy, regardless of any past results or treatment. Women already known to be living with HIV or hepatitis B need early referral into specialist services to plan their care in pregnancy.

If a woman accepts screening, the test involves taking a blood sample from the woman’s arm at the earliest opportunity, usually when booking for antenatal care. This sample will be sent to the laboratory for testing and the screen negative results should be discussed with women at their next maternity appointment. Women who receive a screen positive result should be seen ≤ 10 working days of the screening team receiving the confirmed result from the laboratory.

Trans men who are pregnant should be offered the same antenatal and newborn screening tests as other pregnant individuals.

Find out more about IDPS screening in the programme overview.

End-to-end pathway

The pathway for IDPS consists of the following elements.

The dotted boxes and numbered labels show how the different parts of the pathway map to the generic headings used below.

An accessible text-only version of this pathway is also available.

1. Before screening test

These requirements relate to making sure that screening is offered to the correct people.

Providers must have systems in place to:

  • make sure there are weekly failsafes in place to identify the eligible population, including women who book late or present unbooked in labour without screening results
  • make sure women receive verbal and digital information (see Screening tests for you and your baby (STFYAYB)) about screening for infectious diseases in pregnancy before the tests are undertaken
  • make sure women who are unable to access the digital version of STFYAYB are given a physical copy
  • make sure women are signposted to or given STFYAYB translations or STFYAYB easy guides as appropriate
  • make sure women are offered and recommended screening for HIV, hepatitis B (see ‘Hepatitis B: information on antenatal screening and neonatal immunisation’ in Infectious diseases in pregnancy screening: clinical guidance) and syphilis in every pregnancy, regardless of any past results or treatment (this includes women known to be living with HIV or hepatitis B)
  • make sure all women who are known to be living with HIV or hepatitis B are referred immediately to the screening team
  • screen as early as possible, without delaying to coincide with other appointments
  • offer screening at any point during pregnancy, including on admission to inpatient or delivery wards, if screening is not already complete
  • make sure the woman is aware she can accept or decline screening for all or any of the 3 conditions
  • make sure women who decline any or all of the screening tests know they can ask to be tested at any time during their pregnancy
  • maintain clear and accurate records of the women’s decision in line with local guidelines
  • make sure the screening team formally reoffers screening to women who initially decline on or before 20 weeks gestation (or by 2 weeks if 20 or more weeks gestation)
  • offer repeat testing at any point during pregnancy to women who have disclosed or consider themselves at risk of infection (see the programme handbook)
  • encourage all healthcare professionals involved in screening for infectious diseases in pregnancy to complete the IDPS e-learning resource every 12 months

2. Screening test

These requirements relate to the processes of carrying out the screening test.

Coverage

Providers must have systems in place to return matched cohort data for the:

Carrying out the screening test

Providers must have systems in place to:

  • make sure the practitioner checks the woman has made an informed choice to have the screening test and records the woman’s decision clearly and accurately, in line with local guidelines
  • make sure an interpreter is available if required
  • make sure the appointment includes:
    • pre-test discussion
    • the blood sample being taken and sent to laboratory for testing
    • post-test information – timeframe and process for receiving results
  • obtain samples for all women who accept screening, including those where venepuncture is initially unsuccessful
  • make sure the request form or electronic data request field is compliant with the IDPS minimum data fields for laboratory request forms or electronic requesting, with laboratories being able to identify antenatal samples
  • follow up women who do not attend appointments in line with local guidelines
  • perform urgent screening for women presenting in labour, unbooked or with no reliable record of screening results, and liaise directly with the laboratory to make sure necessary clinical information is provided to inform prompt analyses and receipt of results
  • meet IDPS test standards S04a, S04b and S04c: turnaround times
  • make sure there are weekly failsafes in place to check that:
    • samples taken are received in the laboratory
    • there is a record of all declines
    • samples not fit for purpose are repeated
    • confirmed screen positive results have been communicated

Screening outcome and referral

Providers must have systems in place to:

  • make sure laboratories report results ≤ 8 working days of receipt of the sample and any requests for repeat samples are actioned
  • give results to all women who have screened negative
  • make sure there are weekly failsafes in place to check that all women who miscarry or terminate their pregnancy after screening receive their results and referrals into clinical care are made for those who screen positive
  • make sure all referrals are followed up

3. After screening test (diagnosis)

These requirements relate to the process of following-up women with screen positive results to get a confirmed result.

Providers must have systems in place to:

4. After screening test (intervention)

These requirements relate to the process of following-up people with a confirmed diagnosis and maximising the overall benefits from screening in terms of the final outcome to the person being screened.

Intervention and treatment

Providers must have systems in place to:

Pathway outcome

Providers must have systems in place to provide care to women who have screened positive and entered clinical care, in line with national clinical guidelines for:

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