The document discusses the effects of pregnancy on HIV-positive women and the risks of mother-to-child transmission during delivery. It states that a woman's absolute CD4 count decreases during pregnancy regardless of HIV status, but her percentage of CD4 cells and viral load do not change due to pregnancy. It also notes that invasive obstetric procedures can increase the risk of mother-to-child transmission by exposing the fetus to more infected maternal blood and secretions. Finally, it reports that a cesarean section before labor and membrane rupture can reduce transmission risk by 50-80% compared to other delivery modes for women not on antiretroviral therapy or only on ZDV, but there is no evidence of benefit for

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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.

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