[CG] Infectious diseases screening tests in late bookers

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Late bookers are women who present for the first time on or after 24 weeks pregnancy. This is the stage at which the baby is potentially viable if early labour occurred.

The results of the infectious disease screening tests could affect the management at or after delivery, therefore all infectious diseases screening test results for a woman should be known prior to delivery and certainly before discharge.

If a woman presents to maternity services as a late booker i.e. on or after 24 weeks it is important to ensure that screening has been offered and results are received:

 

1) The woman presents to the antenatal clinic, and there is no immediate risk of delivery

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record.
  • Mark the  sample  as  URGENT  and  telephone  the  West of Scotland Specialist Virology Centre to let them know it is in the system. (0141 201 8722). Alternatively, email west.[email protected]. State that the patient is a late booker, provide the lab with a contact phone number and state if you are want to receive the result on Clinical Portal or by phone.
  • Send the sample to the virus lab, via normal routine processes.
  • Ensure that the name and contact details of the person and a deputy who will be responsible for any positive results are clearly appended
  • Note that to view a result on portal a CHI number is essential

2) The woman presents to maternity assessment i.e. in pain, bleeding etc therefore the risk of delivery is high

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next                      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours (9.00 – 17.00 Monday to Friday), telephone the lab on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
    • Alternatively, in hours only, email west.[email protected], flag the email as urgent and state that the patient has a high risk of delivery. Provide the lab with a contact number. They will call you back within an hour.
  • Out of hours (including Saturday and Sunday).
    • Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above. Do not email the lab out of hours or at the weekend. 
  • If the timing of the local transport systems does not facilitate urgent transfer order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link])  
  • In normal hours the lab is able to process and produce results within 1-2 hours of receipt. Note that reactive samples will need to be confirmed on the next day.
  • Note that to view a result on Clinical Portal, a CHI number is essential.

3) The woman presents in labour

It is the responsibility of the labour ward staff to ensure that virology screening tests are offered and results received. Even intrapartum diagnosis can significantly, positively modify neonatal outcome therefore it is important to ensure women are offered screening tests no matter how late.

It is essential that you telephone the virology lab as soon as possible to discuss emergency testing of the woman.

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours (9.00 – 17.00 Monday to Friday), telephone the laboratory on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
  • Out of hours (including Saturday and Sunday) Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above.
  • Order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link]
  • As with ALL emergency blood tests ensure results are followed up immediately they are available. In normal hours the lab is able to process and produce results within 1-2 hours of receipt.  
  • Communication with paediatricians is essential as their management may be significantly altered by these results however the responsibility for taking and sending these investigations and obtaining these results remains with the midwifery / obstetric team.

Last reviewed: 20 March 2021

Next review: 30 April 2023

Author(s): Gillian Penrice

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 357