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A - MSRA Obstetrics [16] > [3] HIV In Pregnancy > Flashcards

[3] HIV In Pregnancy Flashcards

1
Q

Why is recognising and addressing HIV in pregnancy important?

A

There is a risk of infecting the child

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2
Q

What is the most common cause of HIV infection in young children?

A

Mother to child transmission (MTCT)

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3
Q

What percentage of MTCT HIV cases occur transplacentally?

A

1.5-2%

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4
Q

How do the majority of MTCT cases of HIV occur?

A
  • Maternofetal transmission during parturition

- Post-natal breast feeding

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5
Q

When can women be screened for HIV?

A

At booking visit

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6
Q

What infections are recommended to be tested for alongside HIV at booking?

A
  • Syphilis
  • Hepatitis B
  • Rubella
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7
Q

What should you do if a pregnant woman declines HIV testing?

A
  • Document it

- Carefully explore reasons why

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8
Q

When should screening for HIV be offered again after the booking visit?

A

28 weeks

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9
Q

Does negative HIV test at booking rule out neonatal infection?

A

No

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10
Q

Why does a negative booking HIV test not rule out neonatal infection?

A

Maternal infection and seroconversion can occur at any time in pregnancy and lactation

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11
Q

What can increase the risk of MTCT of HIV in pregnancy?

A
  • Higher levels of maternal viraemia
  • HIV core antigens
  • Lower maternal CD4 count
  • Primary HIV infection during pregnancy
  • Chorioamnionitis
  • Co-existing other STD
  • Invasive intrapartum procedures
  • Rupture of membranes
  • Vaginal delivery
  • Preterm Birth
  • Advanced maternal age
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12
Q

What invasive intrapartum procedures can increase the risk of MTCT of HIV?

A
  • Fetal scalp electrodes
  • Forceps
  • Ventouse
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13
Q

When can rupture of membranes particularly increase the risk of MTCT of HIV?

A

If delivery is more than 4 hours after rupture

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14
Q

What can decrease the risk of MTCT of HIV in pregnancy?

A
  • Higher levels of neutralising HIV antibody
  • Elective C-section
  • Zidovudine (ZDV)
  • Less invasive monitoring and intrapartum procedures
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15
Q

How can diagnosis of HIV in the mother affect the risk of MTCT?

A

Earlier diagnosis can reduce the risk of transmission

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16
Q

What interventions can used in the antenatal period to reduce MTCT of HIV?

A
  • Anti-retroviral therapy
  • Elective c-section
  • Avoidance of breast feeding after delivery
17
Q

What are the advantages of anti-retroviral therapy in pregnancy for HIV?

A
  • Helps prevent MTCT

- Prevents maternal disease progression

18
Q

How many anti-retroviral drugs are used at a time in HIV in pregnancy?

A

A combination of 3+

19
Q

By when should a decision about mode of delivery be made in a woman with HIV?

A

By 36 weeks gestation

20
Q

When can a vaginal delivery be planned in a woman with HIV?

A

When they are taking ART and has a plasma viral load of < 50 copies/ml

21
Q

How should women with HIV who opt for vaginal delivery be managed in labour?

A
  • Keep membranes intact as long as possible

- Avoid fetal scalp electrodes and fetal blood sampling

22
Q

Which women with HIV should receive pre-term C-section at 38-39 weeks?

A
  • Those on ART with plasma viral load of > 50copies/ml

- Women on ZDV monotherapy instead of ART

23
Q

How low can the risk of MTCT of HIV be reduced to if all steps are taken?

A

<1%

24
Q

What should the baby of a mother with HIV receive after birth?

A
  • Anti-retrovirals within 4 hours until 4-6 weeks

- HIV testing in first 2 days, on discharge at 6 weeks and 12 weeks

25
Q

If initial HIV tests in the baby are negative what does this mean?

A

As long as the mother is not breastfeeding the baby does not have HIV

26
Q

When should a confirmation test for HIV be performed in a baby?

A

18 months

27
Q

Why should breast feeding be avoided in a mother with HIV?

A

It increases MTCT by ~15%

A - MSRA Obstetrics [16] (61 decks)

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