Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA.
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100123. doi: 10.1016/j.ajogmf.2020.100123. Epub 2020 Apr 28.
In 2016, the incidence of acute hepatitis C virus infection was 1.0 per 100,000 persons in the United States and 6.2 per 100,000 persons in Massachusetts. Hepatitis C virus infection among pregnant women in the United States increased by 89% from 2009 to 2014. The risk of a mother with hepatitis C virus infection transmitting the infection to her infant is approximately 4% to 7%. The Infectious Disease Society of America and the American Association for the Study of Liver Diseases recommend universal hepatitis C virus screening in pregnancy, whereas the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend risk-based screening.
The objective of this quality improvement project was to assess the hepatitis C virus screening practices of obstetricians and gynecologists at a tertiary care center located in a high endemic area for hepatitis C virus infection.
An electronic 10-question survey was reviewed by the Tufts Medical Center Institutional Review Board and found to be exempt from institutional review board approval. The survey was emailed to resident and attending physicians who provide obstetrical care.
Of a total of 41 respondents, 38 (92.6%) provided responses; of these 38 respondents, 17 (44.7%) were attending physicians, 4 (10.5%) were fellows, and 17 (44.7%) were resident physicians. In addition, 16 of 37 (43.2%) respondents answered that all pregnant women should be screened for hepatitis C virus, whereas 20 of 37 (54.1%) respondents thought only pregnant women with risk factors for hepatitis C virus infection should be screened. Furthermore, only 13 of 31 (41.9%) respondents correctly identified all of the recommended risk factors that should prompt screening for hepatitis C virus. When asked about their clinical practice, 5 of 36 (13.9%) respondents indicated that they screen all pregnant patients, whereas 28 of 36 (77.8%) respondents indicated that they screen patients based on their risk factors for hepatitis C virus infection.
Our survey showed that risk-based screening for hepatitis C virus may be less effective than universal screening because healthcare providers are not consistent in identifying risk factors for hepatitis C virus infection. Universal screening could decrease the amount of hepatitis C virus infections that go undiagnosed in pregnancy.
2016 年，美国每 10 万人中有 1.0 人感染急性丙型肝炎病毒，马萨诸塞州每 10 万人中有 6.2 人感染。美国孕妇丙型肝炎病毒感染人数从 2009 年到 2014 年增加了 89%。患有丙型肝炎病毒感染的母亲将感染传染给婴儿的风险约为 4%至 7%。传染病学会和美国肝病研究协会建议在怀孕期间对丙型肝炎病毒进行普遍筛查，而美国妇产科医师学会和母胎医学学会则建议进行基于风险的筛查。
本质量改进项目旨在评估位于丙型肝炎病毒感染高发地区的三级保健中心的妇产科医生的丙型肝炎病毒筛查实践。
塔夫茨医疗中心机构审查委员会审查了一份包含 10 个问题的电子调查，发现该调查无需机构审查委员会批准。该调查通过电子邮件发送给提供产科护理的住院医师和主治医生。
在总共 41 名受访者中，有 38 名（92.6%）做出了回应；在这 38 名受访者中，17 名（44.7%）是主治医生，4 名（10.5%）是研究员，17 名（44.7%）是住院医师。此外，37 名受访者中有 16 名（43.2%）认为所有孕妇都应筛查丙型肝炎病毒，而 37 名受访者中有 20 名（54.1%）认为只有丙型肝炎病毒感染风险因素的孕妇才应筛查。此外，只有 31 名受访者中的 13 名（41.9%）正确识别了所有建议的丙型肝炎病毒筛查触发因素。当被问及他们的临床实践时，36 名受访者中有 5 名（13.9%）表示他们筛查所有孕妇，而 36 名受访者中有 28 名（77.8%）表示他们根据孕妇丙型肝炎病毒感染的风险因素进行筛查。
我们的调查显示，基于风险的丙型肝炎病毒筛查可能不如普遍筛查有效，因为医疗保健提供者在识别丙型肝炎病毒感染风险因素方面并不一致。普遍筛查可减少怀孕期间未确诊的丙型肝炎病毒感染数量。
