HIV In Pregnancy Flashcards
Why is recognising and addressing HIV in pregnancy important?
There is a risk of infecting the child
What is the most common cause of HIV infection in young children?
Mother to child transmission (MTCT)
What percentage of MTCT HIV cases occur transplacentally?
1.5-2%
How do the majority of MTCT cases of HIV occur?
- Maternofetal transmission during parturition
- Post-natal breast feeding
When can women be screened for HIV?
At booking visit
What infections are recommended to be tested for alongside HIV at booking?
- Syphilis
- Hepatitis B
- Rubella
What should you do if a pregnant woman declines HIV testing?
- Document it
- Carefully explore reasons why
When should screening for HIV be offered again after the booking visit?
28 weeks
Does negative HIV test at booking rule out neonatal infection?
No
Why does a negative booking HIV test not rule out neonatal infection?
Maternal infection and seroconversion can occur at any time in pregnancy and lactation
What can increase the risk of MTCT of HIV in pregnancy?
- 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
What invasive intrapartum procedures can increase the risk of MTCT of HIV?
- Fetal scalp electrodes
- Forceps
- Ventouse
When can rupture of membranes particularly increase the risk of MTCT of HIV?
If delivery is more than 4 hours after rupture
What can decrease the risk of MTCT of HIV in pregnancy?
- Higher levels of neutralising HIV antibody
- Elective C-section
- Zidovudine (ZDV)
- Less invasive monitoring and intrapartum procedures
How can diagnosis of HIV in the mother affect the risk of MTCT?
Earlier diagnosis can reduce the risk of transmission
What interventions can used in the antenatal period to reduce MTCT of HIV?
- Anti-retroviral therapy
- Elective c-section
- Avoidance of breast feeding after delivery
What are the advantages of anti-retroviral therapy in pregnancy for HIV?
- Helps prevent MTCT
- Prevents maternal disease progression
How many anti-retroviral drugs are used at a time in HIV in pregnancy?
A combination of 3+
By when should a decision about mode of delivery be made in a woman with HIV?
By 36 weeks gestation
When can a vaginal delivery be planned in a woman with HIV?
When they are taking ART and has a plasma viral load of < 50 copies/ml
How should women with HIV who opt for vaginal delivery be managed in labour?
- Keep membranes intact as long as possible
- Avoid fetal scalp electrodes and fetal blood sampling
Which women with HIV should receive pre-term C-section at 38-39 weeks?
- Those on ART with plasma viral load of > 50copies/ml
- Women on ZDV monotherapy instead of ART
How low can the risk of MTCT of HIV be reduced to if all steps are taken?
<1%
What should the baby of a mother with HIV receive after birth?
- Anti-retrovirals within 4 hours until 4-6 weeks
- HIV testing in first 2 days, on discharge at 6 weeks and 12 weeks
If initial HIV tests in the baby are negative what does this mean?
As long as the mother is not breastfeeding the baby does not have HIV
When should a confirmation test for HIV be performed in a baby?
18 months
Why should breast feeding be avoided in a mother with HIV?
It increases MTCT by ~15%
