HIV causes AIDS by weakening a person's immune system. It is transmitted through sexual contact, blood and from mother to child. Early diagnosis and treatment can prevent mother-to-child transmission which occurs during pregnancy, childbirth or breastfeeding. With treatment, transmission can be reduced to less than 5%, but without around 15-30% of babies will be infected. Managing HIV in pregnancy requires antiretroviral treatment, nutritional support, monitoring for infections, and strategies to prevent transmission during delivery such as cesarean section instead of breastfeeding.

1. PREPARED BY: - Shreya Mandlik

2.  HIV (Human Immunodeficiency Virus) is a virus that
causes AIDS (Acquired Immunodeficiency Syndrome). An
AIDS infected person cannot fight off diseases as they
would normally and are more susceptible to infections,
certain cancers and other health problems that can be life-
threatening or fatal.

3. Acquired immunodeficiency syndrome (AIDS) is
defined in terms of either a CD4+ T cell count
below 200 cells per µL or the occurrence of specific
diseases in association with an HIV infection

4. HIV is transmitted by three main routes:
 sexual contact
 exposure to infected body fluids or tissues
 from mother to child during pregnancy, delivery, or
breastfeeding (known as vertical transmission)

5. Influenza-like illness
Fever
large tender lymph nodes
throat inflammation
Headache
Sores of the mouth and genitals

6. Nausea
Vomiting
Diarrhea
weight loss
gastrointestinal problems and muscle pains
persistent generalized lymphadenopathy

7. Pneumocystis pneumonia (40%)
Cachexia in the form of HIV wasting syndrome (20%)
Esophageal candidiasis
Recurring respiratory tract infections
Opportunistic infections
people with aids have an increased risk of developing
various viral induced cancers including

8. Kaposi's sarcoma
Burkitt's lymphoma
primary central nervous system lymphoma
cervical cancer

9. Nucleoside reverse transcriptase inhibitors
Nucleotide reverse transcriptase inhibitors
Protease inhibitors
Non Nucleoside reverse transcriptase inhibitors
Entry inhibitors

10. Mother-to-child transmission (MTCT) is when an HIV
positive woman passes the virus to her baby.
This can occur during pregnancy, labour and delivery,
or breastfeeding.
Without treatment, around 15-30% of babies born to
HIV positive women will become infected with HIV
during pregnancy and delivery.
A further 5-20% will become infected through
breastfeeding.

11. Pregnancy (Maternal Factors)
Post-partum (Infant Feeding Factors)

12. Labour and Delivery (Obstetric Factors)
Infancy (Infant Factors)

13. Antenatal
 In utero by transplacental passage.
Intranatal
• Exposure to maternal blood and vaginal secretions
during labor and delivery.
Postnatal
• Postpartum through breastfeeding.

14. Obstetrical
Prolonged rupture of membrane( longer than 4 hours)
Mode of delivery
Intrapartum hemorrhage
Obstetrical procedures
Invasive fetal monitoring

15. Fetal
Prematurity
Genetic
Multiple pregnancy
Infant
Breast feeding
Gastrointestinal tract factors
Immature immune system

16. Mother-to-child transmission (MTCT) of HIV infection
can be greatly reduce through early diagnosis of
maternal HIV infection.
Pregnant women should be offered screening for HIV
early in pregnancy because appropriate antenatal
interventions can reduce MTCT of HIV infection.
Interventions to reduce MTCT of HIV during the
antenatal period include antiretroviral therapy (ART),
elective caesarean section delivery and avoidance of
breast-feeding after delivery.

17. Patient can choose the option of MTP.
Planned optimal care if continuation of pregnancy.
Implementation of strategies to reduce risk of fetal
transmission.
Future planning can be done by couples.

18. Psychological trauma- reduce by counseling.
Risk of social isolation.
Risk of marital disharmony.

19. Multifaceted
Management
Antenatal Care
Obstetrical
Management
Examinations and
Investigations
Medical Treatment
During Pregnancy
Antiretroviral
Therapy
Care During
Labour and
Delivery

20. Most HIV positive women will be asymptomatic
and have no major obstetrical problems during
their pregnancies.
They should receive similar obstetric antenatal
care to that given to HIV-negative women, unless
indicated by the need to provide specific HIV
related treatment.

21. The care of the HIV positive woman during
pregnancy should include ongoing counseling and
support as an integral part of the management.
Advice on the possible risks of unprotected
intercourse during pregnancy should be provided.

22. Invasive diagnostic procedures, such as chorionic villus
sampling, amniocentesis or cordocentesis should be
avoided where possible, due to a possible risk of
infection of the fetus.
External cephalic version of a breech fetus may be
associated with potential maternal-fetal circulation
leaks and the advantages and disadvantages of the
procedure should be very carefully considered.

23. Maternal weight should be monitored and nutritional
supplementation advised where necessary.
The oro-pharynx should be examined at each visit, for
the presence of thrush.
Syphilis testing should be undertaken, and repeat
testing in late pregnancy may be advisable.
Anemia is more common in HIV-infected women and
repeated hemoglobin tests may be helpful.

24. In general, pregnancy is not a contraindication for the
most appropriate antiretroviral therapy for a woman or
for most of the medical management of HIV-related
conditions, but the risk to the fetus should always be
considered, and treatment modified if necessary.
The value of Vitamin A supplementation in reducing
transmission has not been proven, but multivitamins
may provide cost effective nutritional support

25. Mebendazole should be given at first visit in areas of
high hookworm prevalence.
If treatment for opportunistic infections is necessary,
it should be used in pregnancy, depending on the
clinical stage of the patient. Treatment regimens
should follow local policy guidelines and where a
variety of treatment options are available, those with
the lowest risk to the fetus should be used.

26. The use of antiretroviral drugs in pregnancy should be
considered for two indications: the health of the
mother and prevention of transmission. Pregnancy
should not be a contraindication for antiretroviral
therapy in the mother, if indicated.

27. Care during labour for HIV positive women should
follow routine practice in most respects.
Prolonged rupture of membranes should be avoided,
as mother-to-child transmission is increased where
membranes are ruptured for more than four hours.
Artificial rupture of membranes should not be
undertaken if progress of labour is adequate.
Episiotomy should not be performed routinely, but
reserved for those cases with an obstetrical indication.

28. Symptoms generally develop by 6 months of age.
 Diarrhea
 Failure to thrive
Most of these children die before their second
birthday.
Children born to HIV-infected parents are likely to
become orphans.

29. approximately 600,000 HIV-infected infants are born
every year-at least 1,600 every day-in resource-
constrained countries.
Transmission occurs during pregnancy, labor and
delivery, and breastfeeding.
The rate of mother to child transmission has been
reduced to less than 5 percent among the limited
number of HIV-infected women in developed
countries.

30. Preventing HIV infection among women of
childbearing age.
Preventing unwanted pregnancy among HIVpositive
women.
preventing mother to child transmission during
pregnancy, labor and delivery, and breastfeeding.

31. Prevention and treatment of anemia (balanced
diet and nutritional supplementation)
Avoiding invasive testing procedures in pregnancy
 Amniocentesis
 Chorionic villus sampling
 External cephalic version
Multivitamin supplementation
Tetanus toxoid immunization

32. Application of good infection prevention practices
during pelvic examinations and delivery.
Avoiding unnecessary artificial rupture of
membranes.
Avoiding prolonged labour and prolonged rupture
of membranes.
Avoid unnecessary trauma during delivery:
 Unnecessary episiotomy
 Forceps delivery
 Vacuum extraction

33. Irrespective of the HIV status handle with gloves
until maternal blood and secretions have been
washed off.
Avoid hypothermia.
Give antiretroviral agents according to the
recommendation (Neverapiine for six weeks), if
available.
Watch for anaemia.
Follow up infant for infection.

34. Cut cord under cover of a lightly wrapped gauze swab,
to prevent blood spurting.
Handle all babies regardless of the mother's HIV
status with gloves until maternal blood and secretions
are washed off.
All babies irrespective of HIV status should be kept
warm post-delivery.
If the mother has decided not to breastfeed, place the
baby on the mother's body for skin-to-skin contact.
Provision should be made to provide the mother with
infant formula

35. Vitamin K should be administered as per national
guidelines.
BCG should be administered according to the
national/WHO immunization guideline.
Antibiotic or 1% silver nitrate eye ointment should
be administered as prophylaxis against ophthalmia
neonatorum according to the national/WHO
immunization guideline.

36. Institute NVP to the baby within 72 hrs.
Determine mother's feeding choice before attaching to
breast.
Clean injection site with surgical spirits before
administering injection.
Do not use suction unless absolutely necessary.

37. Daily Neverapiine for six weeks

38. Complications
Preterm Labour
(Abruption Placentae
& Rupture of
Membrane)
Spontaneous
Abortion
Still Births
(usually assc.
with ifx)
Low Birth
Weight
Ectopic
Pregnancy
Infections

39.  Imbalanced nutritional status less than body intake
 Acute/ Chronic pain
 Impaired skin integrity
 Impaired oral mucus membranes
 Fatigue
 Anxiety and fear
 Ineffective sleeping pattern
 Disturbed thought process
 Social isolation
 Powerlessness
 Deficient knowledge
 Risk for infection
 Risk for injury
 Risk for deficient fluid volume