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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
View the documentEffect of HIV infection on pregnancy
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
View the documentCounselling before and after HIV testing in pregnancy
View the documentCounselling about pregnancy-related issues
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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
View the documentCare of neonates
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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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Vaginal cleansing

The use of antiseptic or antiviral agents to cleanse the birth canal during labour and delivery has been hypothesized as a possible approach to reducing intrapartum transmission of HIV-1. The use of chlorhexidine lavage to reduce the transmission of group B streptococci was demonstrated in Scandinavian studies299. The concept is attractive for HIV prevention, as it would be an inexpensive intervention, readily achievable in most health care settings, would not require identification of HIV-infected women prior to the intervention and could have other health benefits.

A Malawian quasi-randomized study compared four-hourly aqueous chlorhexidine 0.25% solution by vaginal swabbing after vaginal examinations and a chlorhexidine wash for the baby, with a control group receiving no wash. No overall reduction was shown in the rate of HIV transmission in the study group, however, only 60% of infants were followed up. There was a significant reduction in transmission in mothers who had ruptured membranes for more than four hours222. Most deliveries in this trial occurred within a short time of the vaginal swabbing procedure. Significant reductions in neonatal and puerperal sepsis were also seen following this intervention300 and use of this procedure may be advantageous for these other health benefits, in addition to any possible role in prevention of mother-to-child transmission of HIV301.

Benzalkonium Chloride has been suggested as an alternative antiseptic agent for vaginal lavage, utilizing the antiseptic from 36 weeks gestation in an attempt to maximize the possible benefit (Table 3). The intervention of vaginal cleansing remains a feasible option for resource poor settings and further research work should be undertaken on different concentrations or formulations of agents and methods of application to determine whether the efficacy can be improved.