For women who have to take ARV during pregnancy it can be a reminder of their HIV status and take away from the normality of their pregnancy. Listen now to Rachel talk about her experience of managing her HIV during her pregnancy....

Impact of HIV on delivery choices

• When last available VL is undetectable, consider factors that might increase the risk of MTCT:
  • Concurrent sexually transmitted infections (STIs)
  • Non adherence to ARV since last Viral load test
  • Amnionitis

If no other risks the woman’s management during labour and delivery should follow the same guidelines as for any pregnant woman

• Women not on ARV or if VL is above the undetectable threshold:
  • Prescribe and administer ARV STAT
  • Avoid vaginal delivery where possible
  • Aim to deliver <6 hours from rupture of membranes (ROM) by caesarean section (CS)
  • If  normal vaginal delivery (NVD) is unavoidable, avoid fetal scalp monitoring and fetal blood sampling, forceps are preferable to ventouse if an instrumental delivery required
  • Contact HIV team (Obs and Gynae HIV consultant, GUM consultant, Neonatal team) as soon as possible

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