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close this bookHIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)
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View the documentEXECUTIVE SUMMARY
View the documentINTRODUCTION
close this folderSECTION A : HIV IN PREGNANCY
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View the documentEpidemiology of HIV
close this folderSusceptibility of women to HIV infection
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View the documentBiological factors
View the documentSocio-cultural factors
View the documentEffect of pregnancy on the natural history of HIV infection
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close this folderMother-to-child transmission
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View the documentFactors affecting mother-to-child transmission of HIV-1
View the documentInterventions to prevent mother-to-child transmission of HIV
close this folderAppropriate interventions to reduce mother-to-child transmission
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View the documentAntiretroviral therapy
View the documentImmune therapy
View the documentNutritional interventions
View the documentMode of delivery
View the documentVaginal cleansing
View the documentModification of infant feeding practice
close this folderVoluntary HIV counselling and testing in pregnancy
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View the documentTesting of antenatal women
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View the documentCounselling about pregnancy-related issues
close this folderSECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN
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close this folderAntenatal care
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View the documentObstetrical management
View the documentExamination and investigations
View the documentMedical treatment during pregnancy
View the documentAntiretroviral therapy
View the documentCare during labour and delivery
View the documentPostpartum care
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close this folderSECTION C : INFECTION CONTROL MEASURES
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View the documentUniversal precautions
close this folderRisks of needlestick injuries
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View the documentManagement of needlestick injuries and other accidental blood exposure
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Examination and investigations

HIV positive women should have a full physical examination at the first visit. Particular attention should be paid to any signs of HIV-related infections [particularly tuberculosis], oral or vaginal thrush, or lymphadenopathy. Herpes zoster [shingles] in a young woman is often an early sign of HIV infection and current herpes lesions or the scars from previous infection may be found. Other co-existent sexually transmitted infections, especially syphilis, are common in HIV positive women96,97,370,371 and may increase the risk of transmission and the level of virus in vaginal and cervical secretions. Clinical diagnosis and treatment of vaginal or cervical inflammation, abnormal discharge or STI should be a priority. The pregnant woman should be monitored for any signs of HIV-related opportunistic infections and for any other intercurrent infections, such as urinary or respiratory infection. Maternal weight should be monitored and nutritional supplementation advised where necessary. The oro-pharynx should be examined at each visit, for the presence of thrush.

Laboratory investigations will depend upon the available resources of the health service. Syphilis testing should be undertaken, and repeat testing in late pregnancy may be advisable40. A haemoglobin estimation is mandatory and a complete blood count should be performed and T cell subset investigations undertaken where possible. Anaemia is more common in HIV-infected women and repeated haemoglobin tests may be helpful. Viral load estimation may provide a valuable prognostic indicator, where available. A cervical smear should be performed if this has not been undertaken within the recent past. Colposcopy should be reserved for women who have an abnormal cervical smear result.