Quality standard

Quality statement 3: Referral to and assessment by specialist care for pregnant women who are identified as hepatitis B surface antigen-positive at antenatal screening

Quality statement 3: Referral to and assessment by specialist care for pregnant women who are identified as hepatitis B surface antigen-positive at antenatal screening

Quality statement

Pregnant women who are identified as hepatitis B surface antigen (HBsAg)-positive at antenatal screening are assessed by a specialist within 6 weeks of receiving the screening test result.

Rationale

Specialist assessment within 6 weeks of receiving the screening test result is important to allow antiviral treatment (tenofovir) in the third trimester if needed to reduce the risk of the baby becoming infected with hepatitis B.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that pregnant women who are identified as being HBsAg-positive at antenatal screening are assessed by a specialist within 6 weeks of receiving the screening test result.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from service pathways or protocols.

Process

Proportion of pregnant women who are identified as being HBsAg-positive at antenatal screening who are assessed by a specialist within 6 weeks of receiving the screening test result.

Numerator – the number in the denominator who are assessed by a specialist within 6 weeks of receiving the antenatal screening test result.

Denominator – the number of pregnant women who are identified as being HBsAg-positive at antenatal screening.

Data source: UK National Screening Committee Key performance indicators – KPI ID2 (Antenatal infectious disease screening – timely referral of hepatitis B-positive women for specialist assessment).

Outcome

Vertical transmission rates from mother to child.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (antenatal care) ensure that healthcare professionals refer all pregnant women who are identified as being HBsAg-positive at antenatal screening to specialist care.

Healthcare professionals refer pregnant women who are identified as being HBsAg-positive at antenatal screening to a specialist within 6 weeks of receiving the screening test result.

Commissioners (clinical commissioning groups) work with partners in secondary care to ensure that specialist services are available to provide pregnant women who are identified as being HBsAg-positive at antenatal screening with specialist assessment within 6 weeks of receiving the test result. Clinical commissioning groups and NHS England area teams (screening and immunisation teams) work together to ensure that providers of antenatal care refer pregnant women who are identified as being HBsAg-positive at antenatal screening to a specialist.

Pregnant women who are found to have hepatitis B infection during antenatal testing are assessed by a specialist within 6 weeks of receiving the screening test result.

Source guidance

Hepatitis B (chronic): diagnosis and management. NICE guideline CG165 (2013, updated 2017), recommendation 1.2.4

Definitions of terms used in this quality statement

Specialist care assessment

Pregnant women who are identified as HBsAg-positive are seen by a hepatologist, or a gastroenterologist or infectious disease specialist with an interest in hepatology. [NICE's guideline on hepatitis B (chronic), recommendation 1.2.4]

Equality and diversity considerations

Pregnant women with complex social needs may be less likely to access or maintain contact with antenatal care services. Examples of women with complex social needs include, but are not limited to, women who:

  • have a history of substance misuse (alcohol and/or drugs)

  • have recently arrived as a migrant, asylum seeker or refugee

  • have difficulty speaking or understanding English

  • are aged under 20 years

  • have experienced domestic abuse

  • are living in poverty

  • are experiencing homelessness.

It is therefore appropriate that special consideration is given to these groups of women.