An audit of obstetricians' management of women potentially infected with blood-borne viruses.
OBJECTIVE
To assess obstetricians' current antenatal screening practices for blood-borne viruses (hepatitis B, hepatitis C and HIV) and how they manage pregnant women infected with a blood-borne virus.


METHODS
National cross-sectional survey conducted between September 2002 and January 2003. All obstetricians (n = 767) registered with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) were mailed a questionnaire assessing their antenatal screening practices and knowledge of management of women potentially infected with a blood-borne virus.


METHODS
Concordance of clinical practice with RANZCOG recommendations and current evidence-based guidelines.


RESULTS
523 obstetricians (68% response rate) completed the questionnaire. Fifty-one per cent of respondents said they would always offer HIV screening and 60% would always offer HCV screening. For HIV-infected women, 36% of obstetricians would always recommend elective caesarean section and 33% would always avoid rupture of membranes. Despite a lack of evidence, 34% of obstetricians advise patients that the risk of HBV transmission is increased with breastfeeding, and 47% give the same advice about HCV transmission.


CONCLUSIONS
There is some discordance between the RANZCOG antenatal screening recommendations for HCV and HIV and current practice. Knowledge about the management of HIV-infected women could be improved, and more obstetricians need to be aware that current evidence suggests there is no increased risk of transmission of HBV or HCV with breastfeeding.
Giles
Michelle L
ML
Clinical Microbiology and Infectious Disease, Royal Women's Hospital, 132 Grattan Street, Parkville, Victoria 3050, Australia. michelle.giles@rwh.org.au
Sasadeusz
Joseph J
JJ
Garland
Suzanne M
SM
Grover
Sonia R
SR
Hellard
Margaret E
ME
D001315:Australia; D017848:Blood-Borne Pathogens; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy / Q000635:transmission; D006509:Hepatitis B / Q000175:diagnosis* / Q000628:therapy / Q000635:transmission; D006526:Hepatitis C / Q000175:diagnosis* / Q000628:therapy / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening; D009520:New Zealand; D009774:Obstetrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011296:Prenatal Diagnosis; D012306:Risk