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Table 1 Audit standards used

From: Management of hepatitis B in pregnant women and infants: a multicentre audit from four London hospitals

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
  1. *Where DNA measurement has been performed to inform maternal management. HBV (hepatitis B virus), HBsAg (hepatitis B surface antigen), HBeAg (hepatitis B e antigen), anti HBe (hepatitis B e antibody), HBIG (Hepatitis B immunoglobulin).