Clinical Practice Resources

The Nova Scotia Vaccine Expert Panel has updated resources for care providers to use with pregnant and breastfeeding individuals to guide discussion about COVID-19 vaccination. This information is specific to adult immunization.

In addition to these documents, the IWK has produced a video to help individuals make an informed choice about whether to get the COVID vaccine while they are pregnant, trying to get pregnant or breastfeeding. The video is hosted on the IWK public website: https://www.iwk.nshealth.ca/COVID-19/vaccine-info-for-pregnant-or-breastfeeding

For more resources related to the care of pregnant patients and their newborns affected by COVID-19, please refer to our COVID-19 Resources page.

This document describes care and services for heathy populations and contains guidance in four key areas: Reducing Health Inequities; Promoting and Supporting Healthy Infant Development; Promoting and Supporting Parent Postpartum Physical and Emotional Well-Being; and Supporting Healthy Transitions and Follow-up.

Syphilis and Screening in NS for Pregnant Persons and Newborns

The rate of syphilis in Canada has been steadily rising in recent years, becoming a significant public health concern. A surge in syphilis infection among women of childbearing age has led to more cases of congenital syphilis (transmission from the pregnant person to the fetus during pregnancy), which can result in severe health outcomes or death in newborns. An infographic created by the Public Health Agency of Canada provides a visual aid depicting the increase in syphilis rates in Canada. Cases of syphilis in pregnancy and confirmed cases of syphilitic stillbirth are reportable to Public Health. The rise in cases has led to national research exploring strategies to address infectious and congenital syphilis in Canada. 

Screening

Screening recommendations for syphilis during the antenatal and postpartum periods, and for newborns are provided below.  These recommendations have been in place since 2020, were adapted from national guidelines, and remain in place until further notice. See the letter to care providers from January 2020 for additional practice guidance regarding consultation, testing and treatment.
Perform syphilis serology:

• Early in pregnancy for all pregnant persons.
• Repeat for all pregnant persons at 24 -28 weeks gestation.
  • For patients considered at high risk for syphilis, repeat syphilis serology at the time of birth.
• For patients considered at high risk for syphilis, repeat syphilis serology at the time of birth.
• In pregnant persons who experience a stillbirth from 20 weeks gestation onward.
• In pregnant persons who have NOT had the recommended syphilis serology during pregnancy, complete the screening prior to discharge following birth.
• In infants presenting with symptoms or signs compatible with early congenital syphilis even if the parent was seronegative at birth, due to the possibility of a very recent parental infection. 

Provincial Syphilis Outbreak: Recommendations for pregnant persons and newborns

As of January 20, 2020, the Office of the Chief Medical Officer of Health for Nova Scotia has declared a provincial syphilis outbreak. Across Canada syphilis outbreaks have been declared in most provinces/territories, due to increasing rates of infection. Changes to recommendations for pregnant women and newborns are outlined in the documents below:

The Canadian Paediatric Society (CPS) has recommended moving from universal newborn ocular prophylaxis, to universal prenatal screening for Neisseriae gonorrhoeae (GC) and Chlamydia trachomatis (CT) and treatment of those with positive results in order to eradicate infection and prevent intrapartum transmission to the newborn.

As universal ocular prophylaxis is eliminated from routine newborn care, functions of the health system must be optimized and synchronized to prevent ON. RCP has partnered with clinical experts and stakeholders from across NS to produce these resources, which are designed to offer guidance for the prevention of ON: