HIV in Pregnancy based on RCOG Guideline 2010

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HIV and
Pregnanc
y
Pregnancy Effects on HIV
 In all women, the absolute CD4 count decreases no matter whether HIV-
positive or negative (pregnancy does not make HIV worse)
 In HIV-positive women, percentage of CD4 cells should not change and viral
load should not change because of pregnancy

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HIV and
Pregnanc
y
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

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HIV and
Pregnanc
y
Delivery: 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% compared with other modes of
delivery in women on no antiretroviral therapy or on ZDV alone
 No evidence of benefit with cesarean section after onset of labor or
membranes have been ruptured
 Give antibiotic prophylaxis for cesarean section in HIV-infected women
International Perinatal HIV Group 1999;
Semprini 1995.

10. THANK YOU