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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -7 مورد

Intrapartum management for pregnant women [FN1] with HIV in resource-abundant settings*

Intrapartum management for pregnant women [FN1] with HIV in resource-abundant settings*
  VL status of the mother
Undetectable VL
(<50 copies/mL)
within 4 weeks of delivery		 Detectable VL
(≥50 copies/mL)
but ≤1000 copies/mL
within 4 weeks of delivery		 VL >1000 copies/mL
within 4 weeks of delivery
Risk for HIV transmission Low risk High risk High risk
Preferred delivery mode Determined by obstetric indications Determined by obstetric indications Scheduled cesarean delivery at 38 weeks
Intrapartum antiretrovirals Continue baseline ART regimen
  • Continue baseline ART regimen
  • Consider intrapartum intravenous zidovudineΔ◊
  • Continue baseline ART regimen
  • Intrapartum intravenous zidovudine◊
Other intrapartum interventions Avoid fetal scalp electrodes
  • Avoid artificial rupture of membranes
  • Avoid operative delivery with forceps or vacuum extractor
  • Avoid fetal scalp electrodes
  • Avoid artificial rupture of membranes (if not undergoing cesarean)
  • Avoid operative delivery with forceps or vacuum extractor (if not undergoing cesarean)
  • Avoid fetal scalp electrodes

This table reflects the general principles of intrapartum management for pregnant women with HIV.

Women who present in labor with unknown HIV status (or a prior negative test with subsequent risk factors for HIV infection) should undergo rapid combination antibody/antigen HIV testing. If this test is positive, the woman and her infant should be managed as high risk for HIV transmission (>1000 copies/mL viral load within 4 weeks of delivery) while awaiting confirmatory testing.

ART: antiretroviral therapy; VL: viral load.

* We recognize that not all pregnant, postpartum, and lactating individuals identify as women or mothers. The topics discussed here are based on risks driven by pregnancy and transmission of infection to the fetus/infant, and apply regardless of the pregnant person's gender identity. For simplicity, we use the term "woman" to signify the pregnant person and the term "mother" to signify the birthing biological parent of a child (regardless of gender identity and/or parental rights).

¶ In the United States, clinicians can consult with the National Perinatal HIV/AIDS Clinical Consultation Center at 1-888-448-8765 to help rapidly develop an individualized plan for individuals who present in labor or with ruptured membranes.

Δ Clinicians may reasonably add intrapartum zidovudine for such patients, particularly if there were concerns about adherence to ART during pregnancy. We typically use intrapartum zidovudine at this VL range.

◊ Intrapartum zidovudine is administered intravenously with a 2 mg/kg dose followed by a continuous infusion of 1 mg/kg/hour until delivery. For women undergoing scheduled cesarean delivery, zidovudine is initiated 3 hours before the procedure. For women who present in labor and have not received antepartum ART, intravenous zidovudine should be administered immediately.

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