 | HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.) |
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| | EXECUTIVE SUMMARY |
| | INTRODUCTION |
|  | SECTION A : HIV IN PREGNANCY |
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| | Epidemiology of HIV |
| | Susceptibility of women to HIV infection |
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| | Biological factors |
| | Socio-cultural factors |
| | Effect of pregnancy on the natural history of HIV infection |
| | Effect of HIV infection on pregnancy |
| | Mother-to-child transmission |
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| | Factors affecting mother-to-child transmission of HIV-1 |
| | Interventions to prevent mother-to-child transmission of HIV |
| | Appropriate interventions to reduce mother-to-child transmission |
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| | Antiretroviral therapy |
| | Immune therapy |
| | Nutritional interventions |
| | Mode of delivery |
| | Vaginal cleansing |
| | Modification of infant feeding practice |
| | Voluntary HIV counselling and testing in pregnancy |
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| | Testing of antenatal women |
| | Counselling before and after HIV testing in pregnancy |
| | Counselling about pregnancy-related issues |
| | SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN |
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| | Antenatal care |
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| | Obstetrical management |
| | Examination and investigations |
| | Medical treatment during pregnancy |
| | Antiretroviral therapy |
| | Care during labour and delivery |
| | Postpartum care |
| | Care of neonates |
| | SECTION C : INFECTION CONTROL MEASURES |
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| | Universal precautions |
| | Risks of needlestick injuries |
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| | Management of needlestick injuries and other accidental blood exposure |
| | REFERENCES |
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Needlestick injuries occur relatively commonly in obstetric practice and health workers should know their local policy for the appropriate management of injury. The most common form of injury occurs when re-sheathing needles. Injuries from hollow needles are more dangerous than those from solid surgical needles, as they are more likely to transfer blood.
Any such injury carries a risk of exposure to HIV, Hepatitis virus, and other pathogens. For Hepatitis B the risk of infection is between 5% (HBV-e Ag negative source patient) and 43% (HBV-e Ag positive source patient). The amount of blood required to transmit Hepatitis B is only 0.00004 ml, while a minimum of 0.1 ml is required for HIV transmission. All health care workers should have Hepatitis B vaccinations, in view of the high risk of accidental transmission, and high prevalence in many developing countries.
Estimates of the risk of HIV transmission from patient to health care worker vary from 0.23% to 0.5% per exposure384,396,397,398,399. The type of exposure and the stage of the HIV positive source patient affect the risk, since the viral load will be greater in the recently infected patient and in late stages of the disease. The estimated risk of transmission of HIV from a deep needlestick injury from an HIV-positive patient is 0.4%, and the estimated risk of transmission from a trans-cutaneous exposure is 0.05%.
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