Guidance

Infectious diseases in pregnancy screening standards valid for data collected from 1 April 2023

Updated 7 February 2023

Applies to England

IDPS-S01: coverage: HIV

Description

The proportion of pregnant women eligible for human immunodeficiency virus (HIV) screening for whom a confirmed screening result is available at the day of report.

Rationale

To provide assurance that screening is offered and recommended to all eligible women and each woman accepting screening has a confirmed screening result.

Definition

Numerator: number of pregnant women for whom a confirmed screening result was available for HIV at the day of report.

Denominator: number of pregnant women booked for antenatal care during the reporting period, including women who present in labour without a confirmed screening result in this pregnancy.

This excludes women who:

• miscarry between booking and testing

• opt for termination between booking and testing

• transfer out between booking and testing (do not have a result)

• transfer in who have a result from a screening test performed elsewhere in the NHS in this pregnancy

Screening is formally reoffered at less than or equal to 20 weeks of pregnancy (or within 2 weeks if more than 20 weeks pregnant) to women who decline the first offer.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: maternity service and screening laboratory

Responsible for data quality and completeness: maternity service

Responsible for submission: maternity service

Reported by: maternity service

Published by: maternity service

This standard is also the key performance indicator ID1

Reporting period

Quarterly: data to be collated between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

Review dates

Date standard introduced: April 2010

Date standard last updated: April 2023

---

IDPS-S02: coverage: hepatitis B

Description

The proportion of pregnant women eligible for hepatitis B screening for whom a confirmed screening result is available at the day of report.

Rationale

To provide assurance that screening is offered and recommended to everyone who is eligible and that each woman who chooses to accept screening has a confirmed screening result.

Definition

Numerator: number of pregnant women for whom a confirmed screening result was available for hepatitis B at the day of report.

Denominator: number of pregnant women booked for antenatal care during the reporting period, including women who present in labour without a confirmed screening result in this pregnancy.

This excludes women who:

• miscarry between booking and testing

• opt for termination between booking and testing

• transfer out between booking and testing (do not have a result)

• transfer in who have a result from a screening test performed elsewhere in the NHS in this pregnancy

Screening is formally reoffered at less than or equal to 20 weeks of pregnancy (or within 2 weeks if more than 20 weeks pregnant) to women who decline the first offer.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: maternity service and screening laboratory

Responsible for data quality and completeness: maternity service

Responsible for submission: maternity service

Reported by: maternity service

Published by: maternity service

This standard is also the key performance indicator ID3

Reporting period

Quarterly: data to be collated between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

Review dates

Date standard introduced: April 2010

Date standard last updated: April 2023

---

IDPS-S03: coverage: syphilis

Description

The proportion of pregnant women eligible for syphilis screening for whom a confirmed screening result is available at the day of report.

Rationale

To provide assurance that screening is offered and recommended to everyone who is eligible and that each woman who chooses to accept screening has a confirmed screening result.

Definition

Numerator: number of pregnant women for whom a confirmed screening result was available for syphilis at the day of report.

Denominator: number of pregnant women booked for antenatal care during the reporting period, including women who present in labour without a confirmed screening result in this pregnancy.

This excludes women who:

• miscarry between booking and testing

• opt for termination between booking and testing

• transfer out between booking and testing (do not have a result)

• transfer in who have a result from a screening test performed elsewhere in the NHS in this pregnancy

Screening is formally reoffered at less than or equal to 20 weeks of pregnancy (or within 2 weeks if more than 20 weeks pregnant) to women who decline the first offer.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: maternity service and screening laboratory

Responsible for data quality and completeness: maternity service

Responsible for submission: maternity service

Reported by: maternity service

Published by: maternity service

This standard is also the key performance indicator ID4

Reporting period

Quarterly: data to be collated between 2 and 3 months after each quarter end.

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

Review dates

Date standard introduced: April 2010

Date standard last updated: April 2023

---

IDPS-S04: test: turnaround times HIV, hepatitis B, syphilis

Description

The proportion of screening test results reported in less than or equal to 8 working days of sample receipt.

This standard is in 3 parts: S04a (HIV), S04b (hepatitis B) and S04c (syphilis).

Rationale

To enable timely reporting of screening test results to women and referral to specialist services if required.

Definition

Numerator: number of screening results reported by the screening laboratory to the maternity service in less than or equal to 8 working days of sample receipt.

Denominator: number of screening samples received in the screening laboratory for each infection in the reporting period excluding samples received:

• that are not fit for analysis and a repeat sample is requested

• with missing information required for testing

Date of sample receipt in the laboratory is counted as day 1. Sample receipt is when the sample is recorded as received on the laboratory information management system.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 97.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: screening laboratory

Responsible for data quality and completeness: screening laboratory

Responsible for submission: screening laboratory via maternity service

Reported by: maternity service

Published by: maternity service

Reporting period

Annually by 30 June 

Review dates

Date standard introduced: April 2016

Date standard last updated: April 2023

---

IDPS-S05: referral: timeliness to information and support

Description

The proportion of women with confirmed screen positive results for HIV, hepatitis B or syphilis attending an appointment in less than or equal to 5 working days to discuss their results.

This standard is reported in 3 parts: S05a (HIV), S05b (hepatitis B) and S05c (syphilis).

Rationale

To provide assurance that women with a confirmed screen positive result for HIV, hepatitis B or syphilis are referred, receive timely information, and interventions where appropriate.

Definition

The IDPS programme recommends all women are offered and recommended screening for HIV, hepatitis B and syphilis in every pregnancy regardless of previous results or treatment. Women known to be living with HIV or hepatitis B who decline retesting in this pregnancy should be seen in less than or equal to 5 working days for referral, timely information, and interventions where appropriate. The date the screening team are informed of the woman’s known positive infection status is day 1.

The appointment should be face-to-face or can be virtual if that is the woman’s choice and meets their individual needs.

S05a (HIV)

Numerator: number of women with confirmed screen positive results for HIV attending an appointment less than or equal to 5 working days to discuss their result.

Denominator: number of women booked in the reporting period with confirmed screen positive results for HIV.

S05b (hepatitis B)

Numerator: number of women with confirmed screen positive results for hepatitis B attending an appointment less than or equal to 5 working days to discuss their result.

Denominator: number of women booked in the reporting period with confirmed screen positive results for hepatitis B.

S05c (syphilis)

Numerator: number of women with confirmed screen positive results for syphilis attending an appointment less than or equal to 5 working days to discuss their result.

Denominator: number of women booked in the reporting period with confirmed screen positive results for syphilis.

A confirmed screen positive result is where a complete and final result is reported by the laboratory on the screening sample. The date the maternity service receives the result is counted as day 1.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 97.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: maternity service

Responsible for data quality and completeness: maternity service

Responsible for submission: ISOSS (Integrated Screening Outcome Surveillance Service)

Reported by: maternity service

Published by: maternity service

Reporting period

Annually by 30 June

Review dates

Date standard introduced: April 2016

Date standard last updated: April 2023

---

IDPS-S06: diagnosis/intervention: timely specialist assessment of women with hepatitis B (newly diagnosed or higher infectivity)

Description

The proportion of women with hepatitis B attending an appointment less than or equal to 6 weeks (42 calendar days) for an assessment by specialist hepatitis B services.

Rationale

To provide assurance that women with hepatitis B receive timely assessment and intervention where appropriate.

Definition

Numerator: number of women attending an appointment less than or equal to 6 weeks for assessment by specialist hepatitis B services.

Denominator: number of women booked in the reporting period for whom the maternity service receives a result that is:

• a confirmed hepatitis B screen positive result for the first time in this pregnancy

• a result with higher infectivity markers for a woman known to be living with hepatitis B

The date the maternity service receives the result is counted as day 1.

Higher infectivity markers are defined as:

• HBsAg positive and HBeAg positive

• HBsAg positive and anti-HBe negative

• acute hepatitis B in pregnancy

• HBsAg positive and known to have an HBV DNA level ≥2x10⁵ IU/ml

The appointment should be face-to-face or can be virtual if that is the woman’s choice and meets their individual needs.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 75.0%

Achievable level: greater than or equal to 90.0%

Caveats

None

Data collection and reporting

Data source: maternity service and specialist services

Responsible for data quality and completeness: maternity service

Responsible for submission: ISOSS

Reported by: maternity service

Published by: maternity service

This standard is also the key performance indicator ID2

Reporting period

Quarterly: data to be collated between 2 and 3 months after each quarter end

Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).

Review dates

Date standard introduced: April 2011

Date standard last updated: April 2023

---

IDPS-S07: intervention/treatment: timely administration of neonatal hepatitis B vaccination and immunoglobulin

Description

The proportion of babies born in the reporting period to women with hepatitis B receiving the first dose of vaccination and, if needed, immunoglobulin in less than or equal to 24 hours of birth.

This standard is reported in 2 parts S07a (hepatitis B vaccine) and S07b (hepatitis B immunoglobulin).

Rationale

To provide assurance of timely administration of first dose of neonatal hepatitis B vaccination, and if needed, immunoglobulin in line with ‘Green Book’ recommendations.

Definition

S07a (hepatitis B vaccine)

Numerator: number of babies born in the reporting period to women with hepatitis B, who receive vaccination less than or equal to 24 hours of birth.

Denominator: number of babies born in the reporting period to:

• women who screen positive for hepatitis B

• women known to be living with hepatitis B

S07b (hepatitis B immunoglobulin)

Numerator: number of babies born in the reporting period to women with hepatitis B, who receive immunoglobulin less than or equal to 24 hours of birth.

Denominator: number of babies born in the reporting period who require immunoglobulin.

Immunoglobulin is required if the woman:

• is HBsAg positive and HBeAg positive

• is HBsAg positive, HBeAg negative and anti-HBe negative

• is HBsAg positive where e-markers have not been determined

• had acute hepatitis B during pregnancy

• is HBsAg seropositive and known to have an HBV DNA level equal or above 1x10⁶ IUs/ml in an antenatal sample during this pregnancy (regardless of HBeAg and anti-HBe status)

Immunoglobulin is also required for babies with a birth weight of 1500g or less, born to women with hepatitis B. They should receive immunoglobulin in addition to the vaccine, regardless of the e-antigen status of the woman.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 97.0%

Achievable level: greater than or equal to 99.0%

Caveats

None

Data collection and reporting

Data source: maternity service

Responsible for data quality and completeness: maternity service

Responsible for submission: ISOSS

Reported by: maternity service

Published by: maternity service

Reporting period

Annually by 30 June

Review dates

Date standard introduced: April 2016

Date standard last updated: April 2023

---

IDPS-S08: diagnosis/intervention: timely specialist assessment of women with hepatitis B (lower infectivity)

Description

The proportion of women with hepatitis B attending an appointment less than or equal to 18 weeks (126 calendar days) for assessment by specialist hepatitis B services.

Rationale

To provide assurance that women with hepatitis B receive timely assessment and intervention where appropriate.

Definition

Numerator: number of women attending an appointment less than or equal to 18 weeks for assessment by specialist hepatitis B services.

Denominator: number of women booked in the reporting period for whom the maternity service receives a confirmed screen positive result with lower infectivity markers for a woman known to be living with hepatitis B.

The date the maternity service receives the result is counted as day 1.

Lower infectivity markers include all the following:

• chronic hepatitis B (no evidence of acute infection in pregnancy)

• and will be surface antigen positive, anti-HBe positive

• and an HBV viral load of <2x10⁵

The appointment should be face-to-face or can be virtual if that is the woman’s choice and meets their individual needs.

Performance thresholds

Acceptable level: not set

Achievable level: not set

Caveats

None

Data collection and reporting

Data source: maternity service

Responsible for data quality and completeness: maternity service

Responsible for submission: ISOSS

Reported by: maternity service

Published by: maternity service

Reporting period

Annually

Review dates

Date standard introduced: April 2023