Background:
Hepatitis C (HCV) currently affects at least 1.8% of the US population. The American College of Obstetrics and Gynecology does not recommend routine prenatal screening for HCV, as there is currently no appropriate treatment for HCV during pregnancy and no intervention proven to prevent vertical transmission. Vertical transmission accounts for nearly every new case of childhood HCV.
The approach to HCV as it relates to pregnancy is not established. As most women who have HCV are unaware of their diagnosis, and at least 10% of women with HCV have no identifiable risk factors, appropriate obstetric care of this population and the assurance that children born to HCV-positive mothers are appropriately evaluated is difficult. More aggressive screening strategies during pregnancy may, at minimum, allow for increased access to care for affected mothers and increased certainty that children get appropriate evaluation.


Objectives:
1. To increase awareness of risk factors and appropriate screening for HCV among physicians staffing a university-based prenatal clinic.
2. To create a multidisciplinary model which establishes a continuum of care for HCV-positive patients including obstetrics, adult gastroenterology, and pediatric evaluation.


Methods:
At our university OB/GYN clinic, fliers were placed in physician staff rooms reminding physicians and nurses of risk factors and appropriate testing for HCV. HCV-positive patients were referred to the multidisciplinary clinic providing obstetric care, gastroenterology consultation, and neonatal follow-up.

Results:
Since the inception of this program, 9 women have been identified with Hepatitis C and have sought prenatal care with the multidisciplinary clinic. 3 remain undelivered, 3 were lost to follow up and 3 are currently receiving adult care with gastroenterology and infant care with our pediatric collaborators. Identification of patients appropriate for referral to this multidisciplinary clinic is ongoing.

Conclusion and implications for practice:
In spite of the current absence of maternal pharmacotherapy and perinatal intervention to reduce vertical transmission of HCV, we have developed a successful collaborative model to identify patients at risk and provide comprehensive care to this population. With the current emphasis on HCV at our institution, we will be well-positioned to incorporate forthcoming drug therapies into current management strategies to optimize the care of mothers and infants affected by HCV.