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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
HIV Infection in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
2. Case Scenarios
Scenario #1
Nellie Benally is a 22 y/o G3P0 at 11 weeks gestation who requests an H.I.V. test with her prenatal labs because she has had a previous partner who was an intravenous drug user. Her E.L.I.S.A. and confirmatory Western blot returned positive. This is a desired pregnancy and she wants to know how she could protect her baby from getting her infection.
Scenario #2
Adelina Low Dog is a 29 y/o G3P2 at 16 weeks gestation who is a known H.I.V.-infected woman on triple therapy (zidovudine, lamivudine, and ritonavir) that she has taken consistently for the last 3 years. This is her first pregnancy since beginning therapy. She has been essentially asymptomatic. Her initial labs this pregnancy reveal a CD4+ count of 373/cubic mm. and an H.I.V.-1 R.N.A. of 490 copies/mL. She inquires whether her medicines are safe to continue during her pregnancy.
Scenario #3
Nora Koyukuk is a 32 y/o G5P4 who presents with false labor at 37 weeks. She has had no prenatal care to date. Her initial prenatal labs were drawn at this encounter and included an H.I.V. test. She returns a week later in active labor and her cervical exam is 3 cm dilated, 75% effaced, vertex at a -1 station, membranes intact. It is noted that her H.I.V. serology is positive. How should her labor and delivery be managed?
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