HIGH-RISK PRENATAL CLIENT

PREGESTATIONAL CONDITIONS

Session Objectives

To discuss best practice for antenatal, intrapartum and postpartum care of the HIV-positive mother to reduce mother-to-child transmission To understand more about HIV/AIDS

What is HIV/AIDS?
Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). HIV attacks and destroys white blood cells, causing a defect in the bodys immune system. AIDS may manifest as early as 2 years or as late as 10 years after infection with HIV.

Anyone can get HIV infection. Women especially may not know they are at risk

HIV is treatable. Treatment can prolong a womans life and prevent HIV transmission to her infant during pregnancy Most women who get the HIV test do not have the virus
If a woman is HIV+ during pregnancy, she can get treatment immediately

If a woman is HIV negative during pregnancy, she can learn ways to prevent getting the infection in the future

All information about HIV testing and the results are kept confidential to the extent allowed by law. Federal and state laws protect women with HIV from discrimination
Experts recommend that all pregnant women receive an HIV test regardless of whether a woman thinks she is at risk

Effect of AIDS on Pregnancy

Infertility Repeated abortions Prematurity Intrauterine growth retardation

Stillbirths
Congenital abnormalities Embryopathies

HIV Transmission from Mother to Infant

Antenatal Intranatal Postnatal

HIV cannot be transmitted by:

Casual person to person contact at home or work or in social or public places Food, air, water Insect/mosquito bites Coughing, sneezing, spitting Shaking hands, touching, dry kissing or hugging Swimming pools, toilets, etc.

Reducing pediatric HIV infection and disease involves three stages:

preventing HIV infection among women of childbearing age preventing unwanted pregnancy among HIVpositive women preventing mother to child transmission during pregnancy, labor and delivery, and breastfeeding

Protecting Health Care Workers During Labor and Delivery

Precautions during labor:
Protection from blood and amniotic fluids Protection from sharp instruments

Resuscitation of baby:
No mouth to mouth suction
No mouth to mouth breathing

Precautions following labor:

Proper disinfection of instruments

Proper disposal of placenta and other items

PRETEST COUNSELING
TAKE RISK HISTORY AND COUNCIL REGARDING RISK REDUCTION DISCUSS REASONS FOR TEST PROVIDE INFORMATION TO WOMEN REGARDING TESTING & ILLNESS RISKS & BENEFITS OF TESTING CONFIDENTIALITY OF RESULTS ASSESS WINDOW PERIOD PERSON HAS RIGHT TO REFUSE TESTING

POST-TEST COUNSELING

HIV RESULTS SHOULD BE GIVEN IN PERSON ASSESS PATIENTS UNDERSTANDING ENCOURAGE PATIENT TO EXPRESS FEELINGS AND ASK QUESTIONS NEGATIVE AND INDETERMINATE RESULTS: DISCUSS NEED FOR REPEAT TESTING

Counseling the Pregnant Woman with a Positive HIV Test Result

Meaning of the positive test results Need for medical management

Treatment options for her and/or to reduce perinatal transmission

Importance of social support Referral for social services Collaboration between OB, HIV specialist, and the pregnant woman Counseling is important!

RISK FACTORS:
Certain behaviors can increase your HIV risk. These are some of the most common risk factors:

Having unprotected vaginal, anal, or oral sex with someone who is infected with HIV or whose HIV status you don't know.
Having many sexual partners. Having sex with a sex worker or an IV drug user. Sharing needles, syringes, or equipment used to prepare or inject drugs with someone who is HIV infected. Using needles for piercing or tattooing that are not sterile.

Bisexual partners

Other Possible HIV/AIDS Risk Factors

Other factors may also increase your HIV risk. For example, having sex under the influence of alcohol or drugs may lead to other risky behaviors, such as having unprotected sex. Here are other potential HIV risk factors: Having another sexually transmitted disease (STD), such as herpes, chlamydia, syphilis, or gonorrhea. STDs may cause changes in tissue that make HIV transmission more likely. Having sex after drinking alcohol or taking drugs. Having a mother who was infected with HIV before you were born. Having had a blood transfusion or received blood products. Having fewer copies of a gene that helps to fight HIV. Although not yet available, a screening test might one day be able to identify those who are more likely to get HIV and develop AIDS.

Treatment can be difficult if:

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include: Nausea, vomiting or diarrhea Abnormal heartbeats

Shortness of breath
Skin rash Weakened bones Bone death, particularly in the hip joints

What You Can Do to Protect Yourself and Others?

Use a latex condom or square of latex or plastic wrap ("dental dam") each and every time you have anal, vaginal, or oral sex. (If you have a latex allergy, use polyethylene condoms with oil-based lubricants.)

Learn more about how to practice safer sex.

Learn about the HIV drug Truvada. It has been approved for use in those at high risk as a way to prevent HIV infection. Truvada should be used in conjunction with safe sex practices. Don't share needles, syringes, or equipment used to prepare injection drugs or to inject them. HIV can stay in syringes for a month or longer. Seek treatment for drug use, but in the meantime, be sure to use a clean needle each time you inject.

 See a qualified professional who uses sterile equipment if you plan to get a tattoo or have your body pierced. Don't share toothbrushes or razors. Talk to a doctor about getting tested for HIV if you are pregnant or planning to become pregnant. If you're HIVpositive, seek counseling and treatment, which can prevent HIV from being passed to a fetus or infant in most cases. Do not breastfeed if you have a newborn and are HIVpositive.

 Should pregnant women get tested for HIV? How is testing done? How can HIV/AIDS affect my pregnancy? What is the chance that my baby will become HIV positive? How will my prenatal care be handled differently if I am HIV positive? Is there safe treatment for women during pregnancy?

Will my baby need treatment after delivery?

CONCLUSIONS
ALL PREGNANT WOMEN SHOULD BE OFFERRED HIV TESTING PRE- & POST- TEST COUNSELING FOR ALL PREGNANT WOMEN TARGETED TESTING OF PREGNANT WOMEN WHO REPORT HIGH RISK BEHAVIOR NOT RECOMMENDED