it expalins about how HIV affects in pregnancy

1. HIV IN PRENANCY

2. By
Jasmi Manu
Asst.professor
Rama College of Nursing

3. HIV and AIDS
 HIV stands for Human Immunodeficiency
Virus
 AIDS stands for Acquired Immune
Deficiency Syndrome, a condition caused by
HIV
 HIV gradually destroys the body’s ability to
fight infections, eventually leading to death
 Incubation period: 2 months-4 years

4. TYPES OF HIV
HIV I HIV II

5. PATHOGENESIS
The virus predominantly
affects the thymus
derived lymphocytes(T
lymphocytes)There is
significant immuno-
deficiency (cell
mediated) of the
affected individual.

6. MODES OF TRANSMISSION
HIV is present in an Infected Person’s: Blood; Semen;
Vaginal secretions & Breast Milk
HIV is transmitted through:
 Unprotected sexual contact with an infected person
 Direct contact with or transfusion of infected blood
 Sharing infected needles e.g. Injecting Drug Users
 From a HIV positive mother to her unborn child, during
birth, through Vertical transmission
 Through infected tissue fluids
 Through breast feeding
For more information please contact: dwivedir@unaids.org,
Mobile: 9810505068

7. CLINICAL PRESENTATION
 Initial presentation :fever, malaise, headache,
sore throat, lymphadenopathy and
maculopapular rash.
 Primary illness may be followed by
asymptomatic period.
 Multiple opportunistic infections with
Candida, tuberculosis, pneumocystis,
neoplasms such as cervical carcinoma,
lymphomas, Kaposi’s sarcoma.
 Constitutional symptoms like weight loss and
protracted diarrhea.

8. CLINICAL PRESENTATION

9. CLINICAL FINDINGS
 CD4 count below 500mm3
 Decreased CD4 / CD8 ratio
 Elevated erythrocyte sedimentation rate
 Elevated serum globulin
 Elevated serum lactate dehydrogenase
 Low serum cholesterol
 Neutropenia
 Thrombocytopenia
 Anemia
 Positive serology for syphilis

10. HIV and Pregnancy
 HIV may have adverse effect on pregnancy
course or outcome
 More than 90% of pediatric HIV/AIDS cases
are caused by MTCT
 Most children born to HIV-positive mothers
 Women without HIV may place themselves at
risk for infection while trying to get pregnant
 Majority of women with HIV are of
childbearing age

11. Prevalence of HIV (Type-1)
among Pregnant Women
0% 10% 20% 30% 40% 50%
Nigeria
Uganda
Kenya
South Africa
Malawi
Rwanda
Botswana
Thailand
Cambodia
Brazil
Honduras
Haiti
% Positive
Source: DeCock et al 2000.
Latin
America
Asia
Africa

12. 0
10
20
30
40
50
60
70
Women, 15-19
Women, 20-24
HIV
prevalence
(%)
HIV Prevalence among
Women Age 15–24
Source: UNAIDS June 2000.

13. Effect of HIV on Fertility

14. Effect of HIV on Fertility
 Prior STIs or pelvic inflammatory disease
 Direct effects of HIV
 Decreased fertility seen after adjustment for age,
lactation, illness, STIs
 Worsened fertility in women with symptomatic
HIV or co-infected with syphilis
 Pregnancy loss more common with HIV infection

15. Adverse Pregnancy Outcomes and HIV
Infection
Pregnancy Outcome Relationship to HIV Infection
Spontaneous
abortion
Limited data, but evidence of possible
increased risk
Stillbirth No association noted in developed countries;
evidence of increased risk in developing
countries
Perinatal mortality No association noted in developed countries,
but data limited; evidence of increased risk in
developing countries
Newborn mortality Limited data in developed countries; evidence
of increased risk in developing countries
Intra-uterine growth
retardation
Evidence of possible increased risk

16. Adverse Pregnancy Outcomes
and Relationship to HIV
Infection
Pregnancy Outcome Relationship to HIV Infection
Low birth weight Evidence of possible increased risk
Preterm delivery Evidence of possible increased risk, especially
more advanced disease
Amnionitis Limited data; more recent studies do not
suggest an increased risk; some earlier studies
found increased histologic placental
inflammation, particularly in those with
preterm deliveries
Oligohydramnios Minimal data
Fetal malformation No evidence of increased risk

17. HIV Testing during
Pregnancy
 Advantages:
 Possible treatment of mother
 Reduce risk of mother-to-
child transmission
 Future family planning issues
 Precautions against further
spread
 If negative, advise about HIV
prevention
 Counseling is important!

18. Preconceptual Counseling

19. Preconceptual Counseling
 Educate patients about perinatal transmission
 To avoid unintended pregnancies
 Counsel patients about safe methods to
conceive
 Choose anti-retrovirals which are known to be
effective in reducing perinatal HIV
transmission
 Attain a stable, maximally suppressed viral
load
 Optimize medical and nutritional status

20. Voluntary Counseling and
Testing (VCT) in Women of
Childbearing Age
 Information about HIV and pregnancy
 Risk assessment
 Prevention of HIV transmission or
acquisition
 Prevention of unintended pregnancy
 Dual protection with condoms

21. Goals of VCT in Antenatal
Care
 Educate about HIV
 Reduce stigma
 Prevent new HIV infections in
pregnancy
 Identify women with HIV
 Stabilize and maintain
maternal health
 Prevent HIV transmission to
uninfected sexual or drug
using partners
 Reduce risk of MTCT
 Plan for future

22. HIV-Related Counseling Issues
During Pregnancy
 Educate/counsel regarding HIV and
pregnancy before pregnancy:
 Impact of HIV on pregnancy and pregnancy
on HIV
 Maternal health
 Long-term health of mother and care for
children
 Perinatal transmission
 Use of antiretrovirals and other drugs in
pregnancy

23. Special Counseling Issues
for HIV-Positive Women
 Effect of HIV on fertility
 Effect of HIV on pregnancy and pregnancy on HIV
 Potential for MTCT
 Risk
 Timing
 Prevention
 Use of antiretroviral (ARV) agents and other drugs
during pregnancy, if available

24. Special Counseling Issues
for HIV-Positive Women
 Newborn feeding options
 Disclosure issues – concerns about
stigma and violence
 Use of condoms
 Long-term health of mother and care
for children
 Pregnancy termination option – if legal
and safe

25. “Opt-Out” HIV Testing in
Pregnancy
Advantages:
 Easier and quicker for the
provider
 Greater percentage of
women likely to be tested
means fewer infected
infants
 “Normalizes” HIV testing

26. “Opt-Out” HIV Testing in
Pregnancy
Disadvantages
 Risk of no pretest counseling
 Patient education may be inadequate
 Provider may not be prepared to give
positive results

27. Opt-Out as a “Consenting
Process”
 Minimum information
 An HIV test is part of the routine pregnancy
screening tests
 You have the right to refuse the test
 The HIV test is important. We strongly recommend
that all pregnant women be tested because a woman
can pass HIV to her baby
 If a woman has HIV, she will be offered medicines for
her health and to reduce the risk
of passing HIV to her baby
 Services are available for her and her family

28. Mother-to-Child
Transmission
 25–35% of HIV positive pregnant
mothers will pass HIV to their newborns
 In the absence of breastfeeding:
 30% of transmission in utero
 70% of transmission during the delivery
 Meta-analysis showed 14% transmission
with breastfeeding and 29% transmission
with acute maternal HIV infection or recent
seroconversion

29. Timing of Mother-to-Child
Transmission
Early Antenatal
(<36 wks)
Late Antenatal
(36 wks to labor)
Late Postpartum
(6-24 months)
Early Postpartum
(0-6 months)
Adapted from N Shaffer, CDC
5-10% 10-20% 10-20%
Labor and Delivery Breastfeeding
Pregnancy

30. MTCT in 100 HIV+ Mothers by
Timing of Transmission
0
20
40
60
80
100
Uninfected: 63
Breastfeeding: 15
Delivery: 15
Pregnancy: 7

31. 31
Estimated Number of Children (<
15 years) Newly Infected with HIV
during 2000
Western Europe
< 500
North Africa
& Middle East
11,000
Sub-Saharan
Africa
520,000
Eastern Europe &
Central Asia
600
East Asia & Pacific
2,600
South &
South-East Asia
65,000
Australia &
New Zealand
< 100
North America
< 500
Caribbean
4,200
Latin America
7,300
Total: 600,000
Source: UNAIDS December 2000.

32. Estimated Timing and Risk of
MTCT of HIV (Absolute Rates)
No
Breastfeedi
ng
Breastfeedi
ng through
6 Months
Breastfeedi
ng through
18–24
Months
Intrauterine 5 to 10% 5 to 10% 5 to 10%
Intrapartum 10 to 20% 10 to 20% 10 to 20%
Postpartum
Early (first 2
months)
5 to 10% 5 to 10%
Late (after 2
months)
1 to 5% 5 to 10%
Overall 15 to 30% 25 to 35% 30 to 45%

33. Factors Affecting MTCT of
HIV/AIDS
 Viral load (HIV-RNA
level)
 Genital tract viral load
 CD4 cell count
 Clinical stage of HIV
 Unprotected sex with
multiple partners
 Smoking cigarettes
 Substance abuse
 Vitamin A deficiency

34.  STIs and other co-
infections
 ARV agents
 Preterm childbirth
 Placental disruption
 Invasive fetal monitoring
 Duration of membrane
rupture
 Vaginal childbirth versus
cesarean section
 Breastfeeding
Factors Affecting MTCT of
HIV/AIDS

35. Recommendations for
Antenatal Care
 Basic antenatal care
 Prevent and treat common
opportunistic infections
 Recommend nutritional interventions
 Screen and treat STIs and other co-
infections
 Monitor for signs and symptoms of
progressive HIV/AIDS
 Counsel on safe sex practices

36. Recommendations for
Antenatal Care
 Avoid invasive procedures
 Amniocentesis
 External cephalic version
 Consider administering ARV agents, if available
 Plan for future
 Newborn feeding
 Family planning
 Long-term care needs for mother, newborn and
other children
 Provide emotional support

37. Recommendations for
Labour and Childbirth
 Avoid invasive procedures
 Artificial membrane rupture
 Fetal scalp electrode or sampling
 Forceps or vacuum extractor
 Episiotomy
 Administer ARV agents, if available
 Consider issues related to type of delivery — cesarean
section versus vaginal childbirth
 Wipe newborn quickly and thoroughly with a dry cloth
to remove maternal blood and secretions

38. Recommendations for
Labour and Childbirth
 Follow recommended infection prevention practices
 Wash hands thoroughly before and after each
procedure and examination
 Wear hand and eye protection
 Handle needles and other sharp instruments
safely
 Dispose placenta and other waste materials and
supplies properly
 Process instruments, gloves and other items by
decontamination, cleaning and either sterilization
or high-level disinfection

39. MTCT and Cesarean
Section
 Cesarean section before
onset of labor and
membrane rupture
decreases risk of MTCT 50–
80%
 Additional benefit in
women not using ARV
agents or on ZDV alone
 No evidence of benefit after
onset of labor or membrane
rupture

40. MTCT and Cesarean Section
Special concerns with cesarean section
in limited-resource settings
 Increased maternal morbidity and possible
mortality
 Availability of blood and blood safety
 Iatrogenic prematurity
 Antibiotic prophylaxis
 Anesthesia availability
 Limited human resources — nursing care
time

41. Postpartum Care
 Assess healing
 Review newborn feeding, growth
and development
 Reinforce safer sexual practices
 Discuss contraception options
 Refer mother and newborn for
ongoing care

42. Recommendations for
Breastfeeding
 Avoid all breastfeeding when replacement feeding is
acceptable, feasible, affordable, sustainable and safe
 Provide guidance and support to HIV-positive
mothers
 Encourage exclusive breastfeeding up to 6
months of infant’s life
 Teach proper attachment of newborn to nipples
and frequent breast emptying
 Teach prevention and recognition and encourage
prompt treatment of mastitis, breast abscess,
cracked nipples and oral thrush or other oral
lesions in newborns

43. HIV/Infant feeding is about Assessing
the risks
Breastfeeding Formula
HIV Mortality

44. Risks of artificial feeding
Increased levels of accute illness:
 Respiratory infections
 Middle ear infection: 3-4x risk
 Gastroenteritis: 3-4x risk (developing countries 17-
25x)
 Bacterial infection requiring hospitalization: 10x
risk
 Meningitis: 4x risk
 Higher mortality from sudden infant death
syndrom (SIDS)

45. Risks of Artificial feeding
Dose-related difference in mental development:
 Lower scores of mental development tests at 18
months
 Difference in mental development and school
performance at 3-5 years
 Lower scores of prematures on intelligence tests at
7-8 years
 Deficits in neurological development (lack of
essential fatty acids)
 Difference in visual acuity

46. Risks of artificial feeding
Effects on the health of mothers:
 Higher risk of impaired bonding, abuse,
neglect and abandonment
 Increased risk of anemia due to early
return of menstruation
 Increased risk of breast and ovarian
cancer
 Increased risk of new pregnancy

47. Global Strategy for Infant and
Young Child Feeding
 Adopted by the WHO and
UNICEF Executive board in
2002
 Recognises that 2/3
deaths of annual 10.9
million U-5 deaths,
occur during 1st yr.
and are related to
inappropriate feeding
practices

48. Interventions to Reduce Mother-
to-Child Transmission
 HIV testing in pregnancy
 Antenatal care
 Antiretroviral agents
 Obstetric interventions
 Avoid amniotomy
 Avoid procedures: Forceps/vacuum extractor,
scalp electrode, scalp blood sampling
 Restrict episiotomy
 Elective cesarean section
 Remember infection prevention practices
 Newborn feeding: Breastmilk vs. formula

49. Antenatal Care
 Most HIV-infected women will be asymptomatic
 Watch for signs/symptoms of AIDS and
pregnancy-related complications
 Treat STDs and other coinfections
 Counsel against unprotected intercourse
 Avoid invasive procedures
 Give antiretroviral agents, if available
 Counsel about nutrition

50. MEDICAL MANAGEMENT
IN HIV IN PREGNANCY

51. Goals of Antiretroviral
Therapy
 To prolong life and improve quality of life
 To suppress HIV to below the limits of
detection or as low as possible, for as long
as possible
 To preserve or restore immune function

52. Antiretrovirals
 Zidovudine
(ZDV):
 Long course
 Short course
 Nevirapine
 ZDV/lamivudin
e (ZDV/3TC)

53. ZDV Perinatal Transmission
Prophylaxis Regimen
Antepartum Initiation at 14–34 weeks gestation and
continued throughout pregnancy
PACTG 076 regimen: ZDV 5 times daily
Acceptable alternative regimen: ZDV 2 or
3 times daily (depending on dose)
Intrapartum During labor, ZDV IV over 1 hour, followed
by a continuous infusion of IV until delivery
Postpartum Oral administration of ZDV to newborn for
first 6 weeks of life, beginning at 8–12
hours after birth

54. HIV-Infected Women in Labor with
No Prior Antiretroviral Therapy
Drug
Regimen
Maternal
Intrapartum
Newborn
Postpartum
Data on
Transmission
Nevirapine One oral
dose at onset
of labor
One oral dose at
age 48–72 hours
(if mother received
nevirapine < 1
hour before
delivery, newborn
given oral
nevirapine as soon
as possible after
birth and at 48–72
hours)
Transmission at 6
weeks 12% with
nevirapine
compared to
21% with ZDV, a
47% (95% CI,
20–64%)
reduction

55. HIV-Infected Women in Labor with
No Prior Antiretroviral Therapy
Drug
Regimen
Maternal
Intrapartum
Newborn
Postpartum
Data on
Transmission
ZDV/3TC ZDV orally at
onset of labor
followed by dose
orally every 3
hours until
delivery AND
3TC orally at
onset of labor,
followed by dose
orally every 12
hours
ZDV orally every
12 hours
AND
3TC orally every
12 hours for 7
days
Transmission at 6
weeks 10% with
ZDV/3TC
compared to
17% with
placebo, a 38%
reduction

56. HIV-Infected Women in Labor with
No Prior Antiretroviral Therapy
Drug
Regimen
Maternal
Intrapartum
Newborn
Postpartum
Data on
Transmission
ZDV IV bolus,
followed by
continuous
infusion of every
hour until
delivery
Orally every 6
hours for 6
weeks
Transmission
10% with ZDV
compared to
27% with no
ZDV treatment,
a 62% (95% CI,
19-82%)
reduction

57. HIV-Infected Women in Labor with
No Prior Antiretroviral Therapy
Drug
Regimen
Maternal
Intrapartum
Newborn
Postpartum
Data on
Transmission
ZDV and
Nevirapine
IV bolus, then
continuous
infusion until
delivery
AND
Nevirapine single
oral dose at
onset of labor
Orally every 6
hours for 6
weeks
AND
Nevirapine single
oral dose at age
48–72 hours
No data

58. Obstetric Procedures
Because of increased fetal exposure to
infected maternal blood and secretions,
increased transmission may come from:
 Amniotomy
 Fetal scalp electrode/sampling
 Forceps/vacuum extractor
 Episiotomy
 Vaginal tears

59. Cesarean vs. Vaginal Birth
 Risk of mother-to-child transmission increased
2% each hour after membranes have been
ruptured
 Cesarean section before labor and/or rupture
of membranes reduces risk of mother-to-child
transmission by 50–80%
 No evidence of benefit with cesarean section
after onset of labor or membranes ruptured
 Cesarean section, increases morbidity and
possible mortality to mother
 Give antibiotic prophylaxis

60. SAFETY PRECAUTIONS
 Needles:
 Take care! Minimal use
 Suturing: Use appropriate needle and holder
 Care with recapping and disposal
 Wear gloves, wash hands with soap
immediately after contact with blood
and body fluids
 Cover incisions with watertight
dressings for first 24 hours

61. SAFETY PRECAUTIONS
 Use:
 Plastic aprons for delivery
 Goggles and gloves for delivery and
surgery
 Long gloves for placenta removal
 Dispose of blood, placenta and waste
safely
 PROTECT YOURSELF!

62. Newborn
 Wash newborn after birth,
especially face
 Avoid hypothermia
 Give antiretroviral agents, if
available

63. Vaccination
 Killed virus, toxoid, or recombinant
vaccines are safe in pregnancy
 Routine vaccinations
 Hepatitis B
 Pneumonia vaccine
 Influenza vaccine
Rubella vaccine and other live, attenuated
vaccines may be given post-partum

64. Breastfeeding issues

65. Breastfeeding issues
If the woman is:
 HIV-negative or does not know
her HIV status, HIV-positive
and chooses to breastfeed
,promote exclusive
breastfeeding for 6 months
 HIV-positive and chooses to use
replacements feedings, counsel
on the safe and appropriate use
of formula

66. National Recommendations

67. National Recommendations for
HIV Testing of Pregnant
Women
 Regulations, laws, & policies about HIV
screening of pregnant women vary state to
state
 Institute of Medicine in 1998 recommended
universal HIV testing of pregnant women
 American College of Obstetrics & Gynecology
and the American Academy of Pediatrics in
encourage counseling but not as a barrier to
testing

68. National Recommendations for
HIV Testing of Pregnant
Women
 Recommendations for HIV screening of pregnant
women
 Prenatal: routine HIV screening for all pregnant
women using the “opt out” approach
 Women will be notified that they will be tested
unless they decline
 Labor and delivery: Routine rapid testing for women
whose HIV status is unknown
 Postnatal: Rapid testing for all infants whose mother’s
status is unknown.

69. Perinatal Transmission of
HIV
 Without antiretroviral prophylaxis, 16%–25%
mother-to-child transmission in North America
and Europe
 21% transmission rate in the U.S. in 1994 before
the standard recommendation of zidovudine (ZDV)
in pregnancy
 With the change in practice, transmission was
11% in 1995
 Today, risk of perinatal transmission can be < 2%
with highly active antiretroviral therapy (HAART),
elective C/S as appropriate and formula feeding

70. Timing of Perinatal
HIV Transmission
 Cases documented intrauterine, intrapartum,
and postpartum by breastfeeding
 In utero 25%–40% of cases
 Intrapartum 60%–75% of cases
 Additional risk with breastfeeding
 14%  risk with established infection
 29%  risk with primary infection
 Current evidence suggests most transmission
occurs during the intrapartum period

71. Breastfeeding and HIV
Infection
 Women with HIV infection in the U.S.
should not breastfeed
 Women considering breastfeeding
should know their HIV status

72. Influences on Perinatal
Transmission: Maternal Factors
 HIV-1 RNA levels (viral load)
 Low CD4 lymphocyte count
 Other infections, Hepatitis C, bacterial
vaginosis
 Maternal injection drug use
 Lack of ZDV during pregnancy

73. Influences on Perinatal
Transmission
 Obstetrical Factors
 Length of ruptured
membranes/
chorioamnionitis
 Vaginal delivery
 Invasive procedures
 Infant Factors
 Prematurity

74. Risk of Perinatal HIV Transmission
 Correlation between high maternal VL and
transmission
 Transmission observed at every VL level,
including undetectable levels
 No HIV RNA threshold below which there was no
risk of transmission
 ZDV decreases transmission regardless of HIV
RNA level
 Recommendation: Initiate maternal ZDV
regardless of plasma HIV RNA or CD4 counts

75. Cesarean Section to Reduce
Perinatal HIV Transmission
 Scheduled C/S offers potential benefit to reduce
perinatal transmission for women with VL  1000
 Unknown whether scheduled C/S offers any benefit
to women on HAART with low or undetectable VL
given the low transmission rate
 Complications of C/S similar to HIV uninfected
women
 Patient’s decision should be respected and honored
 No known benefit of C/S if labor has begun

76. Counseling During Labor
 Not a great time but it is possible!
 Other opportunities: ER visits for false
labor, antenatal admissions, premature
labor
 Materials for patient
education/informed consent
 Policy and procedure in place with a
counseling “script” for providers

77. Formula for HIV Counseling
and Testing in Labor
Confidentiality
Comfort
Consent
Reasons to test
Results
Rx to decrease risk
R3
C3

78. Confidentiality
Who is in the room with the
patient?
How can you assure confidentiality
during
 History taking
 Giving test results
 Giving medication for treatment?

79. Comfort
 What is her level of
discomfort?
 How is her pain being
managed?
 Is she anxious?

80. Informed Consent
 Who is responsible for obtaining informed
consent?
 How much information is “informed?”
 HIV is the virus that causes AIDS
 A woman could be at risk for HIV and not know it
 Effective interventions can protect the infant from
HIV and improve mother’s health
 HIV testing is recommended for all pregnant women
 Services are available to help women reduce their
HIV risk and provide medical care
 Women who decline testing won’t be denied care

81. Reasons for HIV Testing
During Labor
 HIV— the virus that causes AIDS — is spread by
unprotected sexual intercourse
 Therefore, all pregnant women may be at risk for
HIV infection
 A pregnant woman with HIV has a 1 in 4 chance
of passing HIV to her baby if she is not treated
 If a woman with HIV takes antiretroviral
medicine during labor and delivery and her baby
takes the medicine after birth, only 1 in 10 babies
will get HIV

82. Giving Results of Rapid Testing
in Labor
 When and how should results be given?
 Post-test counseling for positive results
 What does a preliminary positive test mean?
 What do you say?
 Post-test counseling for negative results
 What treatment is available if the
preliminary test is positive
 Consent for prophylactic treatment
based on preliminary test results

83. Postpartum Woman with a
Negative HIV Test
 Counseling regarding
risk reduction
 Assessment of on-
going risk
 Referral for intensive
counseling if high
risk

84. Treatment to Reduce
Perinatal HIV Transmission
 Antiretroviral treatment to mother
during labor and delivery and to the
baby after birth decrease the risk of
transmission to 1 in 10
 National guidelines offer 4 choices of
treatment
 Woman with a preliminary positive HIV
test should delay breastfeeding until the
results of
the confirmatory test are known

85. Pre test counseling received Pre test counseling not received
FLOW OF INFORMATION
In laws 6
Natal Family
25
Husband7
Woman
62 %
%
%
%
In laws
14
Natal Family
15
Husband
34
Woman
37%
%
%
%
WHO WHO
other 9
In laws
14
husband
33
Natal
Family
44%
%
%
%
other 4
In laws
37
husband
26
Natal
Family
33 %
%
%
%
WHOM WHOM

86. Consequences
In laws were the major source of stigma in both the groups
“ They say (in laws) I
deceived him (husband).
And so they will not take
any responsibility
“ My in laws have
disowned me, they
asked me to stay at my
natal place. My
husband got remarried.
He never came to see
me / our baby even
once. ”
“My sister in law has
kept all his (husband’s)
things separate. She has
made a separate
arrangement for him
to sleep.”
“They (in laws) don’t
allow me to do any work
at home. I am treated
like an ‘untouchable’.
They don’t take care of
my diet, my health.”

87. Consequences
Natal family was very supportive in almost all the cases
Its because of my
parents that my child
could be saved from
the infection. My in
laws have disowned
me for no fault of
mine.
My mother takes great
care so as I take
medicines on time. She
is the one who
accompanies me to
hospital every time.

88. Consequences

89. Gynecologic Issues in HIV
Infected Women
 Abnormal uterine bleeding
 Pap smears
 Infections/STD screening: GC, chlamydia, HSV, genital
ulcerative disease
 Contraception
 Breast Examinations-mammograms at appropriate age

92. NURSING MANAGEMENT

93. NURSING DIAGNOSIS IN
HIV IN PREGNANCY
 Anxiety related to treatment and complications of HIV
 Knowledge deficit related to treatment modalities in HIV
 Fatigue related to lack of food intake
 Imbalanced nutrition less than body requirement related
to anorexia
 Anticipatory grieving related to chronic and terminal
illness
 High risk of infection related to compromised immune
system
 High risk of acquiring an opportunistic infection related to
poor nutritional status
 High risk for fluid volume deficit related to lack of fluid
intake secondary to gastrointestinal infection.
 High risk for mental and neurological status changes
related to central nervous system infection

94. Summary
 Prevent HIV infection in women in their
childbearing years
 Prevent unintended pregnancies in HIV-
positive women
 Identify HIV infection in pregnant women
 To provide effective antenatal, labor and
childbirth, and postpartum care can be
provided
 To reduce risk of MTCT

95. THANK YOU