HIV in pregnancy Flashcards
Wha tis the most common reason for vertical transmission?
Vaginal delivery
Breastfeeding doubles transmission rate
Membrane rupture for >4h doubles risk
What increases risk of vertical transmission?
Breast feeding Membrane rupture Viral load > 400/ml Seroconversion during pregnancy Advanced disease Preterm labour Hepatitis C
What reduces risk of vertical transmission?
Maternal anti-retroviral use
Elective Caesarean section
Bottle feeding
Neonatal anti-retroviral therapy
What antenatal care for HIV?
Offer HIV test at booking and again at 28 weeks if declined
Arrange multidisciplinary care with HIV physician to monitor viral loads, drug regimens and toxicity monitoring
Check for hepatitis B and C, varicella zoster, measles and toxoplasmosis antibodies
Offer hepatitis B and pneumococcal and influenza vaccines (safe in pregnancy)
Screen for genital infections at booking and at 28 weeks
When do women need highly active antiretroviral therapy? how should this be changed during pregnancy?
Symptomatic HIV
Falling or low CD4 count < 350 x 10^6/L
Continue treatment throughout pregnancy and postpartum
What should you do if a woman is on HAART at booking?
Screen for gestational diabetes and warn of increased risk fo premature labour
What are the requirements for Pneumocystic jirovecii prophylaxis? What is given? What is the significance of this is pregnancy?
CD4 < 200 x 10^6/L
Co-trimoxazole
Add pre-pregnancy/1st trimester 5mg folic acid/day
What should HIV positive women not on HAART do during pregnancy?
Start HAART by 24 weeks taking until delivered
Plan mode of delivery by 36 weeks
What should be done if membranes rupture >34 weeks
Expedite delivery whatever the maternal viral load
What should be done if membranes rupture < 34 weeks?
Give steroids
Give erythromycin
Ensure mother takes usual HAART regimen
Determine delivery balancing risks of prematurity and infection
How do you manage preterm labour without ROM?
Same as in HIV -ve
What mode of delivery in HIV?
Vaginal delivery if viral load < 50 copies/ml (<400copies/ml if on HAART) at 36 weeks
C-section otherwise
What considerations intrapartum in vaginal delivery?
Continue HAART in labour
Avoid fetal blood sampling/scalp electrodes
Avoid amniotomy unless delivery imminent
Oxytocin for augmentation
Low cavity forceps preferred over ventouse (less fetal trauma)
Avoid mid-cavity or rotational forceps
Who should you offer C-section to?
38 weeks gestation to women if on zidovudine mono therapy
If on HAART with viral loads > 400 copies/ml
If co-infected with Hepatitis C and not on HAART
If viral load is < 50 copies/ml and elective section is needed, plan for 39+ weeks
What should be given post-partum?
Cabergoline within 24h of birth to suppress lactation
Newborns treated within 4h of birth e.g. zidovudine twice daily for 4w
HAART if high risk e.g. untreated mother, mother with viral load > 50/ml despirte being on HAART
Co-trimoxazole prophylaxis is given to babies at high risk fo trasmission
