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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
6. Read the material on route of delivery
Women infected with H.I.V. whose viral loads exceed 1000 copies/mL should be counseled regarding the potential benefit of scheduled cesarean delivery at 38 weeks. Data are insufficient to demonstrate a benefit for neonates of women with viral loads less than 1000 copies/mL and show no reduction in the transmission rate if cesarean delivery is performed after the onset of labor or rupture of membranes. The patient's autonomy in making the final decision regarding route of delivery must be respected. Prophylactic antibiotics are appropriate for cesarean delivery because of increased infectious morbidity in H.I.V.-infected women, especially those with low CD4+ counts. Amniocentesis, fetal scalp monitoring, and other invasive procedures should be avoided whenever possible. Newborns should not be subjected to injections and blood draws until they have been thoroughly cleaned of all maternal secretions. Optimally, the zidovudine protocol should be instituted at least 3 hours prior to surgery if the clinical situation permits.
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