Legally Mandated Testing
Although congenital rubella has almost been conquered, the risk of congenital infection with herpes, hepatitis, syphilis, or HIV is increasing. [ACOG Technical Bulletin 114. Perinatal Viral and Parasitic Infections. March 1988.] The laws requiring the reporting of such infections should be carefully followed to allow the health department to investigate the source of the disease. It does not help to treat a woman for syphilis in her first trimester if her consort remains infectious. If she contracts the disease again in the third trimester, the risk of fetal infection is greater than it was before. If the patient or the child is injured by the failure to comply with testing and reporting laws, the physician can be held liable for negligence per se.
It is imperative to consider the possibility of HIV infection in every pregnant woman. [ACOG Committee Opinion 85. Human Immunodeficiency Virus Infection: Physicians’ Responsibilities. Committee on Ethics, September 1990.] Ideally, women should be counseled and tested before becoming pregnant. [ACOG Technical Bulletin 169. Human Immune Deficiency Virus Infections. December 1988.] It is important to counsel and offer testing to every pregnant woman. In some urban centers, more than 1% of pregnant women are already HIV infected, and the rate appears to be increasing. [Novick LF, et al. New York State HIV Seroprevelance Project, Chapter II Newborn Seroprevalence study: methods and results. Am J Pub Health Supp. 1991;81:15–21.] As HIV becomes more prevalent, it is anticipated that states will require prenatal testing for HIV. Until this happens, it is critical that physicians stress the medical necessity of knowing a patient’s HIV status when managing maternal and child health problems. If the patient refuses testing, this should be carefully documented.