OBJECTIVES When you have completed this unit you should be able to: Explain the risk of HIV transmission to the infant during labour and delivery. Identify women at greatest risk of transmitting HIV to their infant. List ways of reducing the risk of HIV transmission to the infant. Describe how to use zidovudine and nevirapine during labour. Reduce the risk of HIV infection of the staff during labour and delivery. Provide family planning advice to HIV positive women after delivery.

COPYRIGHT

All rights reserved. No part of this Perinatal Education Programme may be altered in any way without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care, the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme is believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

ISBN 0 7992 1955-X

33-1 CAN HIV BE TRANSMITTED FROM MOTHER TO INFANT DURING LABOUR AND DELIVERY?

Yes. During labour and delivery the infant is exposed to cervical and vaginal secretions as well as blood, all of which may contain HIV and infect the infant. The risk of HIV transmission is higher during the last weeks of pregnancy, labour and delivery than during the rest of the pregnancy. The greatest risk of HIV transmission from a mother to her fetus is during labour and delivery.

MOST VERTICAL SPREAD OF HIV TAKES PLACE DURING LABOUR AND DELIVERY

33-2 WHAT IS THE RISK OF AN INFANT BEING INFECTED WITH HIV DURING LABOUR AND DELIVERY?

The risk of HIV transmission from mother to infant during pregnancy, labour and delivery together is about 20% if antiretroviral treatment is not used. The risk of HIV transmission during labour and delivery is about 15%. Therefore, most of this transmission takes place during labour and delivery. Efforts to reduce HIV transmission during labour and delivery are, very important. The management of all women in labour needs to be modified as it is often not known which women are HIV positive.

33-3 CAN HIV INFECTION BE DIAGNOSED FOR THE FIRST TIME DURING LABOUR?

If a woman has not been screened for HIV during her pregnancy, she can be screened during labour using a rapid test. It is preferable to screen women for HIV during pregnancy when there is still time for adequate counselling.

33-4 IS THERE ANY NEED TO ISOLATE HIV POSITIVE WOMEN DURING LABOUR?

No. There is no need to isolate HIV positive women before, during or after labour. However, there is a need for privacy when counselling these women.

33-5 MAY THE DURATION OF RUPTURED MEMBRANES INFLUENCE THE RISK OF HIV TRANSMISSION?

Yes. With ruptured membranes the infant is exposed to cervical and vaginal secretions. The longer the duration of ruptured membranes, the greater the risk of HIV in maternal secretions getting into the uterine cavity and infecting the infant. The risk of transmission from mother to infant increases if the membranes have been ruptured for more than 4 hours.

THE RISK OF VERTICAL TRANSMISSION OF HIV TO THE INFANT IS INCREASED IF THE MEMBRANES HAVE BEEN RUPTURED FOR MORE THAN 4 HOURS

*** The risk of HIV infection of the second twin is less than that in the first twin, as the second twin is exposed to maternal secretions for a shorter time.

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