Clinical Practice Guidelines

TO: NS Perinatal Care Providers
FROM: Reproductive Care Program
DATE: June 7, 2016
RE: Zika Virus in Pregnancy


Recommendations for screening pregnant women with potential exposure to Zika virus are evolving. The current screening recommendations are summarized below. Included with this memo are copies of the Nova Scotia ZIKA TESTING ALGORITHM – INTERIM GUIDANCE and the Nova Scotia ZIKA CLINICAL INFORMATION DATA SHEET – INTERIM GUIDANCE.

  • All pregnant women with a potential exposure to Zika virus require assessment, regardless of whether they develop symptoms. Potential exposure is defined as personal travel to a Zika area any time after the date of the woman’s LMP or unprotected sexual contact with a male who has traveled to a Zika area in the last 6 months. For the most recent Zika Virus Travel update refer to the PHAC website at http://travel.gc.ca/travelling/health-safety/travel-health-notices
  • Symptomatic pregnant women should be referred to the Fetal Assessment & Treatment Centre (FATC) at the IWK. These women will need blood and urine specimens collected and sent to the Department of Pathology and Laboratory Medicine, Central Zone as described in the ZIKA TESTING ALGORITHM. The ZIKA CLINICAL INFORMATION DATA SHEET must be completed and sent with the specimens.
  • Asymptomatic pregnant women who have traveled to a Zika area since their last LMP, or have had unprotected sexual contact with a male who has traveled to a Zika area in the last 6 months, should be referred to the FATC for triage. All should be offered Zika virus serology as described in the ZIKA TESTING ALGORITHM and the ZIKA CLINICAL INFORMATION DATA SHEET must be completed and sent with the specimens.  Consultants in the FATC will determine the best timing and location for ultrasound surveillance based on the woman’s individual circumstances, such as timing of exposure and gestational age.
  • The FATC referral form should include the woman’s LMP, the circumstances of her exposure in the context of gestational age (include travel history or history of unprotected sexual contact with a male who may have been exposed to Zika virus), the presence or absence of symptoms consistent with Zika virus in the woman or her partner, the timing of the appearance of symptoms (if relevant), whether or not a blood sample has been sent for Zika serology and, if so, the date the sample was collected.
  • The timing of Zika serology is important.  Zika serology for an asymptomatic pregnant woman should be done NO SOONER than three weeks following the last exposure. At this time Zika serology for male partners of pregnant women is not being offered in Canada. Because all testing is done at one lab in Winnipeg the priority is pregnant women. In addition, the interpretation of a negative test in this context is difficult.
  • The FATC referral form can be found at:  http://www.iwk.nshealth.ca/sites/default/files/IWK_MAFE.pdf or on the IWK website under the tab, ‘For Health Professionals’ and the option ‘Referral Forms for External Physicians’.  A new form must be printed for each referral (due to the barcode) and the form must be faxed to FATC at 902- 470−7987.
  • Remind each pregnant woman that her male partner should use condoms for the duration of the pregnancy.  
  • Remind each woman who could become pregnant, that her male partner should use condoms for 6 months from the time of travel to a Zika area.
  • More detailed information, including links to all current national and international recommendations for pregnant women with regard to Zika virus exposure, is available from the Society of Obstetricians and Gynecologists of Canada at:  http://old.sogc.org/news_items/zika-virus-and-pregnant-women/

Nova Scotia recommendations related to pregnancy and Zika virus exposure will be updated on the RCP website as new information becomes available.  Please check back regularly at http://rcp.nshealth.ca

The Nova Scotia guidelines for antenatal laboratory screening and testing were revised and re-released in June 2015. The guidelines are available in a convenient printable card format. The companion document to the new Nova Scotia Prenatal Record provides detailed information on applying these guidelines.

The authors of Alcohol Use and Pregnancy, Consensus Clinical Guidelines, published by the SOGC in 2010, say "...there is evidence that alcohol consumption in pregnancy can cause fetal harm ... there is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy ... there is insufficient evidence to define any threshold for low-level drinking in pregnancy."

They recommend that "... universal screening for alcohol consumption should be done periodically for all pregnant women and women of child-bearing age. Ideally, at-risk drinking could be identified before pregnancy, allowing for change."

The full guideline along with summarized statements and recommendations is available at: http://sogc.org/guidelines/alcohol-use-and-pregnancy-consensus-clinical-guidelines

Pre-term birth is a significant health issue in Canada. In an effort to avoid unnecessary antepartum admissions or maternal transfers, many jurisdictions have adopted Fetal Fibronectin (ƒFN) testing for women with symptoms of pre-term labour. To assist health-care professionals and planners with the implementation and monitoring of a testing program, a Working Group with representatives from across Canada developed the following resources: a clinical guideline, a presentation, and a list of key indicators. These documents are provided as templates and can be adapted based on local circumstances.
RCP worked in collaboration with regional hospitals across Nova Scotia in 2006 to implement fetal fibronectin (fFN) testing to diagnose preterm labour. Dr. Heather Scott, Obstetrical Co-Director of RCP, Rebecca Attenborough, Coordinator RCP, and Mike Mahaffa, Adeza Biomedical Representative gave a presentation via telehealth on the implementation and use of fFN in Nova Scotia.