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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
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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
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
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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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Counselling about pregnancy-related issues

There are several issues to be addressed when counselling HIV positive pregnant women, in addition to the general issues related to HIV infection. These include information about the interactions of HIV and pregnancy, options of termination of pregnancy, discussion about disclosure to the male partner, the risk of mother-to-child transmission and possible interventions to prevent this, other treatment options, infant feeding and HIV and future fertility. Some of these pregnancy-related issues are detailed in Table 7.

Table 7 : Issues in counselling HIV-positive pregnant women

The effect of pregnancy on HIV infection
The effect of HIV infection on pregnancy outcome: risks of adverse pregnancy events
The risk of transmission to the fetus during pregnancy, delivery and breastfeeding
Termination of pregnancy options
Treatment options during pregnancy
Interventions available to attempt to prevent mother-to-child transmission
Infant feeding options: the advantages and disadvantages of breastfeeding
Disclosure of results to male partners and/or to other significant family or community members: advantages and risks
The need for follow-up of both mother and child
Future fertility and contraceptive options

HIV-infected women should be given appropriate information to make informed decisions about the continuation of their pregnancy and future fertility348. Termination of pregnancy should be offered to HIV positive women; where this is legal. It should be clear to health care workers that offering termination should never be coercive and that all women, irrespective of their HIV status, have the right to determine the course of their reproductive life. Although there are some reports of increased rates of termination in HIV positive women, the majority of women will elect to continue with the pregnancy249,349,350,351. Knowledge of HIV infection had little effect on reproductive trends and the decision on future children in a number of studies248,352,353,354 although this has been seen more in developing countries than developed countries. However, a family planning intervention in Rwanda, providing access to and information about contraceptives, showed a reduction in subsequent pregnancies which was greater than in HIV-negative women355, and other studies have shown a reduction in the number of pregnancies in HIV positive women349,356,357,358.