BACKGROUND:
Infants born to hepatitis B surface antigen (HBsAg) positive women are at extremely high risk of perinatal transmission and chronic infection. However, post-exposure prophylaxis given within 12 hours of birth is 90 -95% effective in preventing perinatal infection. Women who do not receive prenatal care are less likely to have been screened for HBsAg and could possibly have a higher HBsAg positivity rate.

OBJECTIVE:
The purpose of this study is to assess perinatal hepatitis B prevention policies and practices in hospitals which serve high numbers of women who present for delivery without prenatal care and with unknown HBsAg status.

METHOD:
Medical records of women who presented for delivery in 2002 without prenatal care are being reviewed at 25 birthing hospitals.

RESULT:
Chart reviews will be completed in December 2004. All hospitals surveyed thus far have maternal HBsAg screening policies for women admitted without documented HBsAg status. In addition, 100% of hospitals surveyed have standing orders to administer hepatitis B vaccine within 12 hours of delivery to infants of mothers with unknown or positive HBsAg status, and 50% have standing orders for hepatitis B immune globulin (HBIG) within 12 hours of delivery. Thirty percent of hospitals surveyed administer universal hepatitis B birth dose as recommended by AAP and ACIP.

CONCLUSION:
Preliminary findings indicate that the hospitals we have surveyed are appropriately managing women who present for delivery with unknown HBsAg status and that infants are receiving appropriate post-exposure prophylaxis.

LEARNING OBJECTIVES:
Perinatal hepatitis B prevention policies and practices in California birthing hospitals which provide care for high numbers of women who present for delivery without having received prenatal care.