Pregnancy and midwifery considerations in HIV

Geraldine Dunne Clinical Nurse Consultant Paediatric Immunology and Infectious Disease, Sydney Children’s Hospital NSW.   Acknowledgment to Karen Blyth (first edition)  Summary  Introduction and global overview   Pre-conception   Pre-natal period   Emotional care and support during pregnancy  Birth  Mode of feeding   Care of the infant in the first 18 months of life   PEP for the infant.  Infant testing  …

Pregnancy and midwifery considerations in HIV Read More »

For any person or couple planning to conceive, there should be opportunities to consider broad aspects of healthcare.  This includes the importance of folate, healthy weight range, vaccinations, and lifestyle considerations, prior to conception (2). For PLHIV planning pregnancy, additional factors should be considered – appropriate anti-retroviral therapy (ART) as well as counselling and education …

Preconception Read More »

The benefits of a woman knowing her HIV status during pregnancy include the opportunity for her to receive appropriate treatment and care for herself and to prevent transmission of the virus to her unborn baby. A further benefit is prevention of HIV transmission to partners or potential future children.   An HIV diagnosis in pregnancy requires …

Pre-natal Period Read More »

During pregnancy and in the perinatal period, confusion, guilt, anxiety, fear of transmission to the unborn child may arise and require sensitive handling, negotiation, offers of referrals, support, and advocacy. The nurse may link the woman, and her partner/family, to appropriate counselling, peer support, and culturally specific care and provide education to help overcome practical …

Emotional care and support during pregnancy Read More »

Current international guidelines recognise that if a pregnant woman LWHIV has an undetectable HIV VL, vaginal delivery does not increase the risk of HIV transmission to the infant (6).   Maintaining engagement in care is an important role of nursing and midwifery staff to ensure monitoring of women’s VL throughout pregnancy, which will ultimately inform the …

Birth Read More »

Providing opportunities for women to gather information and discuss infant feeding options during pregnancy is ideal, allowing women time to make informed decisions.    Provision of information on the topic of the mode of feeding in a supportive forum is a complex process.  Nurses and midwives need to have expert knowledge of current evidence and guidelines, …

Mode of feeding Read More »

Before hospital discharge following birth, nursing and midwifery staff can provide guidance for the parents/mother about:  administration of PEP to the infant  safe and private storage of ART  ways to maintain confidentiality from visiting family members/friends.  Care coordination can ensure that the woman’s paediatric HIV care team know of the birth, mode of feeding, PEP …

Care of the infant in the first 18 months of life Read More »

PEP is given to the infant within 4 hours of birth and may be given orally, although it can also be given via a nasogastric tube or intravenously. In most cases, if the baby is categorised as ‘very low risk’ or ‘low risk’ of HIV transmission, PEP will be administered for 2 weeks, twice daily …

PEP for the infant Read More »

Testing for the infant is recommended at various intervals until 18 months of age (11), so the woman should feel safe and supported in a non-judgemental care setting.  Maternal antibodies are usually present for at least the first 12 months of the infant’s life, hence the need to delay an HIV antibody test until 18 …

Infant testing Read More »

Effective care coordination for a WLWHIV is paramount. A coordinated, cohesive model enhances engagement in care and avoids difficulties in navigating a complex health system and the potential for loss of follow-up, suboptimal adherence to ART and risking transmission of the virus to the unborn child. (11). For these reasons, a multidisciplinary model is the …

Multidisciplinary care Read More »