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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
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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Care during labour and delivery

Care during labour for HIV positive women should follow routine practice in most respects. Prolonged rupture of membranes should be avoided, as mother-to-child transmission is increased where membranes are ruptured for more than four hours119. Artificial rupture of membranes should not be undertaken if progress of labour is adequate. Given these advantages, this may be introduced as a routine part of the management of labour for all women in high prevalence areas.

There are conflicting reports of the importance of obstetric interventions in the facilitation of transmission111,113. As a general rule, any procedure which breaks the baby's skin or increases the baby's contact with the mother's blood - such as scalp electrodes or scalp blood sampling - should be avoided unless absolutely necessary, due to the unconfirmed magnitude of the risk of these for HIV transmission. Universal precautions should be applied in managing labouring women in all cases. Episiotomy should not be performed routinely, but reserved for those cases with an obstetrical indication.

If an assisted delivery is required, forceps may be preferable to vacuum extraction, given the risk of micro-lacerations of the scalp from the vacuum cup. There is increasing evidence that elective Caesarean section may help prevent transmission of HIV to the baby225. The operation carries risks of maternal complications and is associated with higher post operative morbidity in HIV positive women110. The decision on Caesarean section delivery should be made on an individual basis, taking into account the available facilities, and will not be possible in most developing countries with high HIV prevalence. Prophylactic antibiotics should be given for both elective and emergency Caesarean sections.