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HIV IN
PREGNANCY
B Y, M I S S . A I S H WA RYA
PAT I L

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AIM

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OBJECTIVE

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INTRODUCTION
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• Human immunodeficiency virus (HIV) Causes an incurable infection that leads
ultimately to a terminal disease called acquired immunodeficiency Syndrome (AIDS).
• Worldwide 25-30% of infected patients are women and 90% of them are 20-49 years of
age.
• At the end of 1998, more than thirty-three million people were living with the human
immunodeficiency virus (HIV), almost half of whom were women in their reproductive
years.
• Over one million children are living with HIV, contracted predominantly through
infection from their mothers.
• There is an estimated one and a half million HIV- positive women becoming pregnant
each year, and almost 600 000 children will be infected by mother-to-child transmission
annually: over 1600 each day.

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INCIDENCE
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• Incidence is difficult to work out but the fact remains that the disease
is alarmingly increasing both in developed and developing countries.
It is now a global problem
• The prevalence even in low-risk population in America is close to 1
in 1000.
• The seropositivity rate among US pregnant women is 1-2 per 1000.
• In most Asian Countries the infection rate is less than 0.5%.

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ETIOLOGY

The 3 main route of transmission is via :

 blood, blood products.
 sexual contact
 mother to child in intrauterine infection, perinatal
transmission, or the mother's milk.

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ClickINFECTION
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IN PREGNANCY

• The transmission from mother to fetus is about 30%.

• Fetus may be affected through Uteroplacental transfer, during delivery
by contaminated secretions and blood of the birth canal, and through
breast milk in the neonatal period.
• In most cases, HIV will not cross through the placenta from mother to
baby. If the mother is healthy in all other aspects, the placenta helps
provide protection for the developing infant.
• Unless a complication should arise, there is no need to increase the
number of prenatal visits. As such, healthcare providers should watch for
symptoms of AIDS and pregnancy-related complications of HIV infection.

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Click to editFEATURES
CLINICAL Master title style
• Fever
• Malaise
• Headache
• Sore Throat
• Lymphadenopathy
• Maculopapular Rash
• Multiple Opportunistic Infections (Eg Candida, Tuberculosis, Pneumocystis
Carinii)
• Neoplasms (Cervical Carcinoma, Lymphomas, Kaposi’s, Sarcoma)
• Constitutional Symptoms(weight Loss, Lymphadenopathy, Diarrhea)
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EFFECT Master
OF HIV title style
INFECTION ON PREGNANCY
LOW
BIRTH
WEIGHT
SPONTA
PRETER
NEOUS
-M
ABORTI
LABOUR
ON

COMPLI-
CATION

INFECTI- STILL
ON BIRTHS

ECTOPIC
PREGNA
NCY
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DIAGNOSIS
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 Diagnosis of asymptomatic adult HIV infection is made on the basis of the
presence in the serum of antibodies to the virus.
 Most individuals will produce antibodies within 3 months after the
exposure or During so called ‘window of infectivity ( 3 months), a negative
result will require a repeat test in order to account for the late
seroconversion
There are two commonly used tests for HIV :
1. Enzyme-linked immunosorbent assay (ELISA) is highly sensitive to the
presence of antibodies.
2. Western blot assay has a greater Specificity for HIV and is used to confirm
the presence of antibodies.
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MANAGMENT
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• Prenatal
• All clients should be offered voluntary serologic testing for HIV
infection
• In seropositive cases, additional investigations should be done to
test for other sexually transmitted infections (STIs) Husbands should
be offered serologic testing for HIV
• Counseling about the risk of HIV Transmission to the fetus and
neonates should be made and termination of pregnancy offered.
• Tuberculin test is to be done. If it is positive, a chest x-ray should be
performed. Even if the chest x-ray is negative chemoprophylaxis
with Isoniazid 300 mg orally should be given.
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CONTI…

• Check women have T-lymphocyte count in each trimester. If the count falls to less than
200 cells/UL, the woman should be treated with zidovudine, she should receive
prophylaxis against pneumocystis carinii infection with Trimethoprim 160 mg and
Sulfamethoxazole 800 mg orally, thrice weekly Nevirapine is found to reduce the viral
transmission to breastfeed the infant.
• The progression of the disease is assessed by CD4 lymphocyte Count (gradual fall),
presence of P24 core antigen and decrease titer of P24 antibody.

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CONTI…

INTRAPARTUM:
Women in labor need to check recent viral load to plan the mode of delivery
-Zidovudine is given IV infusion is started at the onset of labor (vaginal
delivery) or 4 hours before cesarean section loading dose 2 mg/kg| hr,
maintenance dose 1 mg/kg/hr until Cord Clamping is done
Women taking highly active antiretroviral therapy (HAART) Can have
planned vaginal delivery when the plasma is viral load is <50 copies/mL.
If plasma loads 750 copies/ml. elective cesarean section is recommended
at 38 weeks for women taking HAART Preopera- time broad-spectrum
antibiotics should be given as per hospital Protocol.

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CONTI…
The cesarean section does not protect the baby from the vertical transmission. It
should only be Obstetric indications before
→ Procedures that might result in break in the skin or mucous membrane of the baby
such as amniotomy, attachment of scalp electrodes and fetal blood sampling should
be avoided.
Healthcare workers should be protected from contact with potentially infected body
fluids
→ caps, waterproof gowns, double gloves, and goggles. Should be worn by the
physician and midwives.
- Disposable needles and syringes should be used and neatly should be placed in
puncture-proof Containers.
→mechanical suctioning devices Should be used to remove Secretions from the
neonate’s air passages.
- Any blood contamination must be washed off the skin immediately
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POSTPARTUM CARE title style
Mothers must be counseled about the risk and benefits of breastfeeding help to
them make an informed choice.
- Zidovudine syrup 2 mg/kg is given to the neonate 4 times daily for the first 6
weeks
- Mother should be encouraged to manage the baby care herself with the
support of the midwife
- Gloves must be worn for examination of the perineum, and cesarean wound
lochia
- Disposal of sanitary pads and disinfection and clearing of any spilled blood
must be done correctly
- Contraception: The barrier method of contraception is effective in preventing
transmission of disease the Simultaneous use of spermicidal agents such as
nonoxynol- 9 is found to improve the efficacy. The diseases could be
prevented predominantly by health education and by the practice of safer sex. 1616
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CONCLUSION

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RESEARCH
Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008
Ira Shah, Mamatha Lala, and Kaizad Damania
Abstract
Aim:
The prevalence of HIV among pregnant women in India is of great concern, especially to prevent HIV in
children. Mother–to–child transmission of HIV is the most common cause of transmission of HIV in children.
The prevalence of HIV infection in pregnant women in India has ranged from 0.7% to 1.2%. Thus, estimating
the prevalence of HIV in pregnant women would aid in developing and prioritizing the prevention of parent-to-
child transmission of HIV programs.
Materials and Methods:
All pregnant women referred to the antenatal clinic from 1993 onward were tested for HIV infection by ELISA
test after pretest counseling. A woman was diagnosed to be HIV infected if she tested positive on more than
two HIV ELISA tests. The prevalence of HIV infection in them was calculated and also whether there was an
increasing trend was determined.
Results:
A total of 123,439 pregnant women were tested for HIV from 1993 to 2004, of which 1797 women were HIV
infected. Overall, the prevalence rate was found to be 1.4%. Prevalence rate from 0.76% in 1993 to 2.37% in
1998. However, from 2004, the prevalence has decreased to 0.6%.
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Conclusion: The prevalence of HIV in pregnant women in Mumbai is decreasing.
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BIBLIOGRAPHY

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THANK YOU

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