Infectious diseases in pregnancy screening standards valid for data collected from 1 April 2018
Updated 7 February 2023
Applies to England
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1. IDPS-S01: coverage: HIV
1.1 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.
1.2 Rationale
To provide assurance that screening is offered and recommended to all eligible women and each woman accepting screening has a confirmed screening result.
Coverage is a measure of the delivery of screening to an eligible population.
Low coverage might indicate that:
- not all eligible women were offered screening
- those offered screening are not accepting the test
- those accepting the test are not tested
1.3 Definition
Numerator: tested women is the total number of eligible women for whom a confirmed screening result was available for HIV at the day of report, including women who were known to be HIV positive at booking and not retested.
Denominator: eligible women is the number of pregnant women booked for antenatal care during the reporting period, or presenting in labour without previously having booked for antenatal care excluding 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
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
1.4 Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: ≥ 99.0%
1.5 Caveats
This requires matched cohort data and follow-up of any missed women.
1.6 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
1.7 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).
1.8 Review dates
Date standard introduced: April 2010
Date standard last updated: April 2018
2. IDPS-S02: coverage: hepatitis B
2.1 Description
The proportion of pregnant women eligible for hepatitis B screening for whom a confirmed screening result is available at the day of report.
2.2 Rationale
To provide assurance that screening is offered and recommended to all eligible women and each woman accepting screening has a confirmed screening result.
Coverage is a measure of the delivery of screening to an eligible population.
Low coverage might indicate that:
- not all eligible women were offered screening
- those offered screening are not accepting the test
- those accepting the test are not tested
2.3 Definition
Numerator: tested women is the total number of eligible women for whom a confirmed screening result was available for hepatitis B at the day of report, including women who were known to be hepatitis B positive at booking and not retested.
Denominator: eligible women is the total number of pregnant women booked for antenatal care during the reporting period, or presenting in labour without previously having booked for antenatal care excluding 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
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
2.4 Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: ≥ 99.0%
2.5 Caveats
This requires matched cohort data and follow-up of any missed women.
2.6 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
2.7 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).
2.8 Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
3. IDPS-S03: coverage: syphilis
3.1 Description
The proportion of pregnant women eligible for syphilis screening for whom a confirmed screening result is available at the day of report.
3.2 Rationale
To provide assurance that screening is offered and recommended to all eligible women and each woman accepting screening has a confirmed screening result.
Coverage is a measure of the delivery of screening to an eligible population.
Low coverage might indicate that:
- not all eligible women were offered screening
- those offered screening are not accepting the test
- those accepting the test are not tested
3.3 Definition
Numerator: tested women is the total number of eligible women for whom a confirmed screening result was available for syphilis at the day of report.
Denominator: eligible women is the total number of pregnant women booked for antenatal care during the reporting period, or presenting in labour without previously having booked for antenatal care excluding 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
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
3.4 Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: ≥ 99.0%
3.5 Caveats
This requires matched cohort data and follow-up of any missed women.
3.6 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
3.7 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).
3.8 Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
4. IDPS-S04: test: turnaround times HIV, hepatitis B, syphilis
4.1 Description
This standard for screening test turnaround time is reported in 3 parts: S04a (HIV), S04b (hepatitis B) and S04c (syphilis).
4.2 Rationale
This standard is needed to monitor the performance of the screening strategy.
4.3 Definition
Numerator: number of results for each infection (confirmed positive or negative) reported to maternity services ≤ 8 working days of sample receipt in the laboratory.
Denominator: samples received is the total number of antenatal screening samples received in the screening laboratory for each infection during the reporting period excluding samples received that are not fit for analysis and a repeat sample is requested from the screening team.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
4.4 Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: ≥ 97.0%
4.5 Caveats
Where samples received are fit for analysis but results are pending (inconclusive) these must be accounted for in the submission commentary and follow-up of any missed results.
4.6 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: screening laboratory
Published by: screening laboratory
4.7 Reporting period
Annually by 30 June
4.8 Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
5. IDPS-S05: referral: timely assessment of screen positive and known positive women
5.1 Description
Timely communication of confirmed screen-positive results for HIV, hepatitis B or syphilis or known positive status (HIV and hepatitis B).
This standard is reported in 3 parts: S05a (HIV), S05b (hepatitis B) and S05c (syphilis).
5.2 Rationale
To provide assurance that all women with HIV, hepatitis B or syphilis confirmed screen positive results (including women with a known positive status for HIV and hepatitis B and not retested) are referred in a timely manner and receive timely intervention.
5.3 Definition
S05a (HIV)
Numerator: number of women with confirmed positive results for HIV or known positive for HIV who attend a screening assessment appointment ≤ 10 working days.
Denominator: number of women with confirmed positive results for HIV or known positive for HIV reported.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
S05b (hepatitis B)
Numerator: number of women with confirmed positive results for hepatitis B or known positive for hepatitis B who attend a screening assessment appointment ≤ 10 working days.
Denominator: number of women with confirmed positive results for hepatitis B or known positive for hepatitis B reported.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
S05c (syphilis)
Numerator: number of women with confirmed positive results for syphilis who attend a screening assessment appointment ≤ 10 working days.
Denominator: number of women with confirmed positive results for syphilis reported.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Timely assessment (numerator) is the total number of women who attended for screening assessment ≤ 10 working days of the:
- screen-positive report being received by the screening team from the laboratory
- women with known positive status notified to screening team
Referral for assessment indicated (denominator) is the total number of women in the reporting period who:
- were reported by the screening laboratory to the screening team as confirmed screen positive for HIV, hepatitis B and syphilis
- were notified to the screening team as known to be HIV or hepatitis B positive
Screening assessment is a face-to-face appointment with a member of the screening team (for example, screening coordinator/specialist midwife/clinical nurse specialist) to facilitate:
- reporting of a new positive screening result
- a comprehensive assessment of women with a known positive status
5.4 Performance thresholds
Acceptable level: ≥ 97.0%
Achievable level: ≥ 99.0%
5.5 Caveats
This standard counts the attendance at an appointment with the screening team within the specified timeframe. It does not count the offer of the appointment.
Providers should be able to demonstrate that reasonable efforts were made to contact the woman and arrange a screening assessment appointment within the specified timeframe.
Where attendance in the timeframe was not achieved these must be accounted for in the submission commentary.
Data for each maternity service may be small and therefore would be aggregated and reported as regional/national figures.
5.6 Data collection and reporting
Data source: maternity service
Responsible for data quality and completeness: maternity service
Responsible for submission: maternity service
Reported by: maternity service
Published by: maternity service
5.7 Reporting period
Annually by 30 June
5.8 Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
6. IDPS-S06: diagnosis/intervention: timely assessment of women with hepatitis B
6.1 Description
The proportion of pregnant women who are hepatitis B positive attending for specialist assessment within 6 weeks of the positive result being reported to the maternity service.
6.2 Rationale
To provide assurance of timely interventions.
6.3 Definition
Numerator: number of pregnant women with hepatitis B who are booked in the reporting period, who have been seen by a specialist within an effective timeframe, including:
- all newly diagnosed hepatitis B positive women
- women already known to be hepatitis B positive with high infectivity markers detected in the current pregnancy
Denominator: number of pregnant women booked in the reporting period who were screened positive (newly diagnosed) for hepatitis B and women already known to be hepatitis B positive with high infectivity as defined as:
- HBsAg positive and HBeAg positive
- HBsAg positive, HBeAg negative and anti-HBe negative
- HBsAg positive where e-markers have not been determined
- having acute hepatitis B during pregnancy
- HBsAg seropositive and known to have an HBV DNA level equal or above 1x106IUs/ml in an antenatal sample
A specialist is a hepatologist, gastroenterologist, infectious diseases physician, or a hepatology nurse specialist working to an agreed protocol within the clinical team.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
6.4 Performance thresholds
Acceptable level: ≥ 70.0%
Achievable level: ≥ 90.0%
6.5 Caveats
None
6.6 Data collection and reporting
Data source: maternity service and specialist services
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 ID2
6.7 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)
6.8 Review dates
Date standard introduced: April 2011
Date standard last updated: April 2018
7. IDPS-S07: intervention/treatment: timely neonatal hepatitis B vaccination and immunoglobulin
7.1 Description
The proportion of babies born in the reporting period to women with hepatitis B receiving first dose of vaccination +/- immunoglobulin ≤ 24 hours of birth.
This standard is reported in 2 parts S07a (hepatitis B vaccine) and S07b (hepatitis B immunoglobulin).
7.2 Rationale
To provide assurance of timely first dose of neonatal hepatitis B vaccination +/- immunoglobulin in line with Public Health England’s ‘Green Book’ recommendations.
7.3 Definition
S07a (hepatitis B vaccine)
Numerator: number of babies born in the reporting period to hepatitis B positive women, who have received vaccination within 24 hours of birth.
Denominator: number of babies born in the reporting period to:
- hepatitis B positive women
- women already known to be hepatitis B positive
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
S07b (hepatitis B immunoglobulin)
Numerator: number of babies born in the reporting period who have received the required immunoglobulin ≤ 24 hours of birth.
Denominator: number of babies born in the reporting period to hepatitis B positive women and women already known to be hepatitis B positive requiring immunoglobulin.
Immunoglobulin is required if the mother:
- 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
- has acute hepatitis B during pregnancy
- is HBsAg seropositive and known to have an HBV DNA level equal or above 1x106IU/ml in an antenatal sample
Immunoglobulin is also required for babies with a birth weight of 1500g or less, born to mothers infected with hepatitis B. They should receive HBIG in addition to the vaccine, regardless of the e-antigen status of the mother.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
7.4 Performance thresholds
Acceptable level: ≥ 97.0%
Achievable level: ≥ 99.0%
7.5 Caveats
Data for each maternity service may be small and therefore would be aggregated and reported as regional/national figures.
7.6 Data collection and reporting
Data source: maternity service
Responsible for data quality and completeness: maternity service
Responsible for submission: maternity service
Reported by: maternity service
Published by: maternity service
7.7 Reporting period
Annually by 30 June
7.8 Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018