HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN: Postpartum care

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

(introduction...)

EXECUTIVE SUMMARY

INTRODUCTION

SECTION A : HIV IN PREGNANCY

(introduction...)

Epidemiology of HIV

Susceptibility of women to HIV infection

(introduction...)

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

(introduction...)

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

(introduction...)

Antiretroviral therapy

Immune therapy

Nutritional interventions

Mode of delivery

Vaginal cleansing

Modification of infant feeding practice

Voluntary HIV counselling and testing in pregnancy

(introduction...)

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

(introduction...)

Antenatal care

(introduction...)

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

(introduction...)

Universal precautions

Risks of needlestick injuries

(introduction...)

Management of needlestick injuries and other accidental blood exposure

REFERENCES

Postpartum care

The postpartum care of HIV positive women should be similar to that for uninfected patients. They do not require separate nursing facilities. Women may, however, require private facilities to lessen the social stigma associated with not breastfeeding if this is the choice they make in a culture which is likely to condemn such behaviour.

HIV positive women are more prone to postpartum infectious complications – including urinary tract, chest, episiotomy and Caesarean section wound infections. Health workers should be aware of this and observe for signs of infection. Mothers should be given information on the early symptoms of infection at the time of discharge, especially where the postpartum hospital stay is short. All mothers should be given instructions on perineal care and the safe handling of lochia and blood stained sanitary pads or materials.

Mothers should be given information on how to care for their babies without the risk of exposure to infection, and full discussion on the risks and benefits of infant feeding choices. If, after counselling, the mother chooses not to breastfeed, she should receive full information on adequate replacement feeding up to two years of age, and guidance on breast care, until lactation stops. Mothers who choose to breastfeed should be advised of the possible increased transmission risk in the presence of cracked nipples, mastitis, breast abscess or of oral lesions in the child and should be taught how to prevent such problems through adequate breastfeeding techniques. Reduced duration of breastfeeding and early cessation may be encouraged to reduce the risk of transmission where this can be achieved safely. The mother should be counselled on the need for follow-up care for her and her child, and the available options for testing of the child. She should be given information about and referred to local HIV support groups. Contraceptive advice should be given and early arrangements made to start with an appropriate method. Contraceptive advice is particularly important when a mother does not breastfeed because of the loss of the contraceptive properties of breastfeeding^380,381.