She has been asked to see you urgently for opinion and advice.
How would you advise with regard to:
the implications of HIV for her especially with regard to pregnancy including antenatal management, delivery and postnatal care.
Also, possible questions pt might raise:
What is the chance of the baby getting AIDS if I don’t do all the things you suggest?
Do I need any other tests?
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answers
The effects on her own health
- If HIV positive her health may deteriorate more quickly in pregnancy
- Early commencement of treatment could give her a longer life expectancy
- She could develop complications of HIV / AIDS
- Repeat screening for other sexually transmitted diseases now & at 28 weeks
- Screen for other viral infections e.g. hepatitis
- Confidentiality of result
Antenatal care & risk of transmission
- The pregnancy should be managed by a multidisciplinary team
- Counsel that the rate of vertical transmission can be reduced to <2%
- Advise antiretroviral therapy during pregnancy
- Defer start of treatment until after first trimester if possible
Delivery & risk of transmission
- May have to deliver by caesarean section
- If undetectable plasma viral load could consider normal birth
- Will manage the labour differently (no fetal scalp electrode or FBS, avoid prolonged rupture of membranes, use forceps instead of ventouse)
- Continue antiretroviral therapy intra-partum
Postnatal & risk of transmission
- Avoid breast feeding
- Treat baby with antiretroviral for 4 – 6 weeks
- Baby be tested for HIV after delivery
- Neonatal testing at 1 day, 6 weeks, 12 weeks, 18 months
Risk of transmitting virus to other people
- Partner could already have HIV
- They should be using barrier contraception
- Extensive contact tracing needed for the sake of any other partners
- Medical and allied professionals looking after her should be aware
Role Player’s Score for ability to engage with the patient and communication skills:
Led the discussion and persuades her to go along with plans for testing
Simple appropriate language and no jargon
Non judgmental approach
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