Clinical Practice Guidelines Antenatal Care — Module II



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7.15Resources


AAOS (2007) Clinical Practice Guideline on the Diagnosis of Carpal Tunnel Syndrome. Rosemont IL: American Academy of Orthopaedic Surgeons.

AAOS (2007) Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Rosemont IL: American Academy of Orthopaedic Surgeons.

Common discomforts in pregnancy. In: Minymaku Kutju Tjukurpa Women’s Business Manual, 4th edition. Congress Alukura, Nganampa Health Council Inc and Centre for Remote Health.

7.16References


Ablove R & Ablove T (2009) Prevalence of carpal tunnel syndrome in pregnant women. Wisconsin Med J 108(4): 194–96.

Baumann F, Karlikaya G, Yuksel G et al (2007) The subclinical incidence of CTS in pregnancy: Assessment of median nerve impairment in asymptomatic pregnant women. Neurol Neurophysiol Neurosci 3.

Borg-Stein J, McInnis C, Dugan S et al (2006) Evaluation and management of musculoskeletal and pelvic disorders of pregnancy. Phys Rehab Med 18(3): 187–204.

Eogan M, O’Brien C, Carolan D et al (2004) Median and ulnar nerve conduction in pregnancy. Int J Gynecol Obstet 87: 233–36.

Finsen V & Zeitlmann H (2006) Carpal Tunnel Syndrome during pregnancy. Scand J Plast Reconstr Surg Hand Surg 40(1): 41–45.

Mabie WC (2005) Peripheral neuropathies during pregnancy. Clin Obstet Gynecol 48(1): 57–66.

Moghtaderi AR, Moghtaderi N, Loghmani A (2011) Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome. J Res Med Sci 16(15): 687–90.

Mondelli M, Rossi S, Monti E et al (2007) Prospective study of positive factors for improvement of carpal tunnel syndrome in pregnant women. Muscle Nerve 36: 778–83.

Niempoog S, Sanguanjit P, Waitayawinyu T et al (2007) Local injection of dexamethasone for the treatment of carpal tunnel syndrome in pregnancy. J Med Assoc Thailand 90(12): 2669–76.

Padua L, Pasquale A, Pazzaglia C et al (2010) Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve 42(5): 697–702.

Palmer K, Harris C, Coggon D (2007) Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occupat Med 57(1): 57–66.

Pazzaglia C, Caliandro P, Aprile I et al (2005) Multicenter study on carpal tunnel syndrome and pregnancy incidence and natural course. Acta Neurochirurgica (Suppl) 92: 35–39.

Shaafi S, Naimian S, Iromlou H et al (2006) Prevalence and severity of carpal tunnel syndrome (CTS) during pregnancy based on electrophysiologic studies. Shiraz E-Medical J 7(3): 1–6.

8Maternal health screening


This section discusses the evidence for offering women tests for anaemia, diabetes, haemoglobin disorders, gonorrhoea, trichomoniasis, Group B streptococcus, cytomegalovirus, toxoplasmosis, cervical abnormalities and thyroid function. Tests for human immunodeficiency virus (HIV), chlamydia, syphilis, rubella, hepatitis B, hepatitis C, asymptomatic bacteriuria, bacterial vaginosis and vitamin D deficiency are discussed in Module I.

Recommendations are based on evidence about the diagnostic accuracy of available tests, the effectiveness of interventions to prevent mother-to-child transmission of infection or other effects on the unborn baby, and the availability of treatments. For some conditions, testing is recommended for all women. For others, testing is recommended only for women who may be at higher risk.

For notifiable infections (HIV, hepatitis B, hepatitis C, rubella, syphilis, chlamydia, gonorrhoea), diagnoses are required to be reported to the National Notifiable Diseases Surveillance System. This allows analysis of trends in jurisdictions and groups at risk, although data quality varies for the different conditions and reporting of Indigenous status is incomplete in some States and for some conditions. Evidence on the prevalence and incidence of other conditions is generally from observational studies and may not be representative of the Australian population or groups within the population. While incidence or prevalence data are not always available, each chapter includes a brief discussion that aims to give health professionals an indication of the likelihood that women in their community will be affected.

Table 8 and Table 8 summarise advice on maternal health screening tests considered a priority for inclusion in these Guidelines. Advice on testing for blood group and rhesus D status is included in the NICE Guidelines (NICE 2008).



Table 8: Summary of advice on screening tests offered to all women during pregnancy9

Condition

Test(s)

Follow-up

Section

Anaemia

Haemoglobin concentration

Full blood count and consideration of possible nutrient deficiencies for women with low haemoglobin concentrations

8.2

Gestational diabetes

Plasma glucose (fasting or following 75 g glucose loading)

Treatment of gestational diabetes reduces the risk of perinatal complications

8.5

Haemoglobin disorders

Full blood count

Further investigations for women with abnormal red cell indices, family history or origin in a high-risk country

8.8

Group B streptococcus*

Self-collected vaginal-rectal swab culture

Identification of colonisation allows treatment during labour to prevent transmission to the baby

9.4

HIV**

EIA and Western blot

Antiretroviral treatment in pregnancy reduces risk of transmission

Module I 8.1

Hepatitis B**


Blood test for HbsAg#

Vaccination of newborn reduces risk of infection

Module I 8.2

Rubella

Blood test for rubella antibody

Vaccination after birth protects future pregnancies. Inadvertent vaccination in early pregnancy is highly unlikely to harm the baby

Module I 8.4

Syphilis#

Treponemal EIA tests

Onsite tests



Treatment benefits mother and prevents congenital syphilis

Module I 8.6

Asymptomatic bacteriuria

Midstream urine culture

Treatment reduces risk of pyelonephritis

Module I 8.7

* According to organisational policy.

** Specialist care and psychosocial support are required for women with HIV or hepatitis B.

# Psychosocial support, partner testing and contact tracing needed for women with sexually transmitted infections.

EIA=enzyme immunoassay; HbsAg=hepatitis B surface antigen; HIV=human immunodeficiency virus.

Table 8: Summary of advice on screening tests offered to women at increased risk



Condition

Offer test to:

Test(s)

Follow-up

Section

Undiagnosed type 2 diabetes

Women with risk factors for diabetes

Plasma glucose (fasting, following 75 g glucose loading or random)

Treatment of pre-existing diabetes reduces the risk of perinatal complications

8.5

Gonorrhoea*

Women with known risk factors or living in areas where prevalence is high

Vaginal, urine or endocervical specimens

NAAT


Treatment may prevent neonatal infection

8.11

Trichomoniasis*

Women with symptoms

PCR testing of vaginal swabs

Treatment may prevent certain infections in the newborn but is associated with adverse effects

9.1

Toxoplasmosis

Women may request testing based on exposure to sources

Studies into tests are limited and inconclusive

Insufficient evidence on treatment. Advice on prevention may reduce the risk of infection

9.7

Cytomegalovirus

Women who have frequent contact with large numbers of very young children

Studies into tests are limited and inconclusive

Insufficient evidence on treatment. Advice on prevention may reduce the risk of infection

9.10

Cervical abnormalities

Women who have not had a Pap smear in the past 2 years

Pap smear

Allows detection of precancerous cervical abnormalities

9.12

Thyroid function

Women with symptoms or risk factors

Blood test for thyroid-stimulating hormone

Treatment improves obstetric outcomes

9.15

Chlamydia*

Women younger than 25 years

All pregnant women in areas of high prevalence



First pass urine

NAAT


Treatment may reduce the risk of preterm birth, premature rupture of the membranes and low birth weight

Module I 8.5

Hepatitis C**

Women with a history of risk factors for hepatitis C

Blood test for hepatitis antibody

RNA if antibodies detected



No interventions are currently proven to prevent transmission

Module I 8.3

Asymptomatic bacterial vaginosis

Women with a previous preterm birth

High vaginal swab

Amsel’s criteria

Nugent’s criteria


Early treatment (<20 wks) may reduce risk of premature rupture of the membranes and low birth weight

Module I 8.8

Vitamin D deficiency

Women considered to be at risk

Blood test for serum 25-OHD

Women at high risk of deficiency may benefit from supplementation

Module I 8.9

* Psychosocial support, partner testing and contact tracing are required for women with sexually transmitted infections.

** Specialist care and psychosocial support are required for women with hepatitis C.

25-OHD=25-hydroxyvitamin D; NAAT=nucleic acid amplification test; PCR=polymerase chain reaction; RNA=ribonucleic acid.




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