HIV in pregnancy
- Zidavudine - significantly dcr. vertical transmission
- Efavirenz & Delavirdine - some teratogenic effect.
- If already on HAART
- First trimester - Stop all but Zidavudine (no studies have shown any HIV meds to be teratogenic, this is just a preference)
- > First Trimester - Cont' HAART (triple antiviral
- Mode of delivery = C-Section
- Breast feeding - NO! use formula
- Perform routine screening of all pregnant women at the first
- If the patient has had no prenatal care, obtain a rapid HIV test
at the time the patient presents to the hospital in labor.
- 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
- Initiate antiretroviral treatment during pregnancy.
- Triple-antiretroviral-therapy regimen is preferable for reducing
mother to child transmission.
- Antiretroviral therapy should be given to the mother antenatally
and at the time of delivery, and to the neonate for the first 4–6
weeks of life
- The risk of adverse events from the drugs is small.
- Give antibiotic prophylaxis as indicated for opportunistic
infections (as with nonpregnant patients).
- Elective C-section in the presence of a high viral
- Recommended at 38 weeks gestation for women with an HIV
RNA load > 1000 copies/mL
- Fetal scalp electrode
- Artificial ROM.
- Breast feeding
- Wash the baby immediately after birth.
- antiretroviral therapy, cesarean section, and avoidance of
breastfeeding can reduce this risk to less than 2%