Management of HIV mother during Labor and breast feeding -Safety concerns

 Q. 10 .How to manage Pregnant women Already Receiving ART ?

Ans:-Pregnant women who are already  receiving ART  for their own health should continue to receive  the same regimen  throughout pregnancy, labor,   breast feeding  period and thereafter  lifelong. If a woman is on an EFV based regimen there is no need to substitute with nevirapine . She must  continue on whatever regimen she is  stabilized on and is responding to adequately

Q.11.Any special management during  Intrapartum ?

Vaginal  delivery is the recommended mode of delivery  for HIV positive mothers according to NACO  guidelines Recent  recommendation of WHO   and NACO  is to do LSCS  only for obstetric indication .

RCOG recommends elective CS at 38 weeks for HIV positive mothers on HAART therapy and vaginal delivery   if viral load is < 50 copies. They also recommend elective CS if viral  load is > 1000 copies ml or unknown. If  the membrane ruptures more than  4 hrs  prior to devilry then CS does not have added advantage over   vaginal delivery for transmission rate.

Q. 13: What should not be done?? Artificial rupture of membrane use of scalp electrodes and scalp  blood sampling increases perinatal transmission rate. Augmentation of labor is done when needed to shorten delivery interval  to decrease transmission.

 Forceps  delivery  and vacuum extrations are avoided , if  possible . PPH is managed with oxytocin  and prostaglnadins. Ergots are avoided  as it interacts with reverse transcriptase and protease inhibitors to cause severe  vasoconstricition

Q. 14: What about PPE?  Universal precautions of all labor  room and OT staff should  be used  for self protection . Avoidance of needle pricks use fo disposable needles and avoidance of contact  with potentially infected body fluids are important as the risk of  infection after mucous membrane exposure  is 0.34%

Q. 15:- What about Neonatal  ART?  

It is important to do the following for infants at 6 weeks

1.                    Reinforce  for exclusive breastfeeding for the first 6 months

2.                    Early infant Diagnosis  testing

3.                    Immunization

4.                    Cotrimozole  initiation and continue until  baby is 18  months old or longer if the baby is confirmed positive

5.                    Stop  Nevirapine prophylaxis for baby  at 6 weeks

 

 

 Management of HIV mother during Labor and breast feeding -Safety concerns

Q. 16 What about Breast feeding  in HIV mothers?? Feeding Options

According  to the National Guidelines for PPTCT, NACO  infants should be given exclusive  breastfeeds for the first six months  preferably Exclusive   replacement  feeding may be done only if the mother  has  died or has a terminal illness or decides not to breastfeed  despite adequate  counseling  Mixed  feeding is contraindicated  as it  increases  the risk of transmission