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