Table 1 Audit standards used

2003 Standards to support the UK antenatal screening programme [[13]]

• Antenatal screening for Hepatitis B should be offered to all women at booking

• Infectivity markers HBeAg and anti HBe determined for all samples confirmed as HBsAg positive; other

• Markers at discretion of physician

• Initial clinical assessment of women identified as HBsAg positive is carried out at the earliest opportunity

• By those with expertise in managing hepatitis B/hepatology

• Referral of partner and family for screening

• First dose of vaccine given at or shortly after birth.

• Immunisation of infant as follows:

Vaccine

HBIG

HBsAg positive & HBeAg positive

Yes

Yes

HBsAg positive without e markers

Yes

Yes

Acute hepatitis B during pregnancy

Yes

Yes

HBsAg positive and anti-HBe positive

Yes

No

2008 update to immunisation green book [14]: Immunisation of infant as above plus:

HBsAg positive, HBeAg negative, anti-HBe negative

Yes

Yes

HBsAg positive & known to have HBV DNA

Yes

Yes

>1 x 10⁶ IUs/ml in an antenatal sample*

2008 British viral hepatitis group guidelines [22]

All newly diagnosed women should undergo appropriate testing, assessment and referral as for non-pregnant individuals (including HBV DNA, Delta virus, HCV, HIV

• Women with HBV DNA >10⁷ IU/ml should be considered for therapy with a potent antiviral agent from 32 weeks of pregnancy