1. JACKIE McGEAGH Regional Antenatal Screening Coordinator PHA
ANTENATAL HEPATITIS B

2. Background Screening pregnant women since 1970s
Formalised in 1998 by DHSSPS
Aim to detect and prevent infection of infant
HBeAG +ve % transmission
HBeAG –ve 10% transmission
Hepatitis B vaccine +/- HBIG at birth
Further vaccine dose 1, 2, 12 months, serology at 12 months for surface antigen
Vaccination confers 90% infection prevention

3. Standards/Guidance 2010 Antenatal Screening Standards
2011 DH Best Practice Guidance
Maternal referral and appt 6 wks within receiving positive result
DNA testing for all women
May require treatment in 3rd trimester
Referral standard implemented Aug 11
Also is a KPI standard

4. Audit of Referrals Retrospective audit conducted in March 2012
Number of women confirmed positive in NIBTS during 2011
Number of pregnant women referred to Liver Unit from Maternity Units
Timeline from referral to appt
Number seen within 6 wks of screening result
Compare pre August 11 and post August 11

5. Findings 35 women identified for 2011 30 HBeAG –ve 5 HBeAG +ve
28 referrals received in 2011
25 referred by Maternity Units, 3 by GP
10 not referred by MU
7 GP 3 in 2011, 4 referred in previous years
1 Gastro referral 2008, not seen since then
A/N referral had appt to attend in 2011
1 not referred – left country

6. Referrals 35 total positives for 2011 21 positives Jan – July 2011
14 positives August – December 2011

7. Maternity referrals Jan - July
12/21 were referred 57%
9 not referred to Liver Unit 43%
Reasons for non referral during
3 referred from GP in 2011
1 left country prior to referral
5 previously referred before 2011 (4 GP, 1 Gastro)

8. Maternity referrals Aug - Dec
13/14 were referred 93%
1 not referred but as existing pt was seen during pregnancy

9. Appointments 12/21 received appointments within 6 wks
50% DNA/Canc first appointment

10. Non Maternity Referrals
Of the 10 not referred from Maternity
9 were yearly review patients
1 was never referred (had care in England)
Of the 9 yearly review patients
1 moved to England and transferred care
8 were seen during pregnancy

11. Conclusions Overall 32/35 women were seen
Improvements from August 2011
Referral from Maternity units improved from 57% to 93%
All women referred met the 6 wk standard
Attendance is still poor with 50% DNA/CNA 1st appointment
High number of repeat DNA/CNA
Screening Coordinators following up in local area

12. Recommendations
Health professionals need to refer all pregnant women during each pregnancy
Women need to be advised to attend during each pregnancy even if previously seen
Further work and research to improve the attendance rates of these women