There are inconsistencies in the management of women potentially infected with blood-borne viruses according to a survey of Australian and New Zealand obstetricians reported in the latest issue of the Medical Journal of Australia.

Obstetricians' knowledge about managing HIV-infected women could be improved, and more obstetricians need to be aware that there is no evidence of increased risk of transmission of hepatitis B (HBV) or hepatitis C (HCV) with breastfeeding.

The survey was carried out by Melbourne researchers Michelle Giles and Margaret Hellard (Macfarlane Burnet Institute for Medical Research and Public Health), Suzanne Garland (Royal Women's Hospital), Joseph Sasadeuz (Royal Melbourne Hospital) and Sonia Grover (Northern and Royal Children's Hospital).

The aim was to survey obstetricians' antenatal screening practices for three blood-borne viruses (HBV, HCV and HIV) and to assess their knowledge base regarding management of pregnant women infected with a blood-borne virus.

Between September 2002 and January 2003, all obstetricians (767) registered with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) were sent a questionnaire. The response rate was 68 per cent.

Although RANZCOG guidelines recommend that all pregnant women should be offered screening for HIV, only 50 per cent of obstetricians said they would always screen for HIV.

Although there is evidence that elective caesarean section reduces transmission of HIV from mother to child, only 36 per cent of obstetricians claimed they would always offer this procedure to HIV-infected women.

Despite a lack of evidence, 34 per cent of obstetricians said they would advise patients that the risk of HBV transmission is increased with breastfeeding, and 47 per cent would give the same advice about HCV transmission.

"The current 'best practice' for hepatitis C screening in pregnant women and interventions during labour to reduce vertical transmission of hepatitis C is far from clear," said Dr Giles.

"However, the current best practice for hepatitis B and HIV is well established."

Possible reasons for the lack of agreement between current practice and RANZCOG guidelines may include a lack of knowledge of the guidelines and/or a belief by some obstetricians that the guidelines do not reflect best practice.

"It is of concern that a substantial proportion of obstetricians are giving incorrect advice about the risk of transmission through breastfeeding," Dr Giles said.

 As a follow-up to the study, educational material has been provided to all obstetricians through publications in their professional journal. A pamphlet has been forwarded to all obstetricians along with feedback on the key questionnaire results.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT                  Dr Michelle GILES                   03 9344 2439

                               Judith TOKLEY                       02 6270 5471 / 0408 824 306