HIV in pregnancy


  1. Zidavudine - significantly dcr. vertical transmission
  2. Efavirenz & Delavirdine - some teratogenic effect.
  3. If already on HAART
  4. Mode of delivery = C-Section
  5. Breast feeding - NO! use formula

DIAGNOSIS
  • Perform routine screening of all pregnant women at the first prenatal visit.
  • If the patient has had no prenatal care, obtain a rapid HIV test at the time the patient presents to the hospital in labor.

TREATMENT

  • Consultation with an HIV specialist.
  • Offer mental health and drug abuse resources as well as behavioral interventions as applicable.
  • Assess current disease status with a CD4 cell count and viral load.
  • Initiate antiretroviral treatment during pregnancy.
  • Give antibiotic prophylaxis as indicated for opportunistic infections (as with nonpregnant patients).
  • Consider elective C-section in the presence of a high viral load.
  • Intrapartum antiretroviral prophylaxis.
  • Avoid fetal scalp electrode, episiotomy, or artificial ROM.
  • Wash the baby immediately after birth.
  • Counsel to avoid breast-feeding.