Care of HIV-Positive Women in Labor

Recommendations for Pregnant Women with HIV and Women/Infants with Preliminarily Positive Rapid HIV Tests

Call the 24/7 IL Perinatal HIV Hotline as soon as possible at 1-800-439-4079 for clinical consultation, referral and follow-up assistance

Inform delivering physician, pediatrician and nurse in charge

Order STAT AZT

  • Mom in labor: 2mg/kg load x 1 hour, then 1mg/kg/hr until delivery
  • Newborn: 4mg/kg PO syrup Q 12 hours (<35 weeks: Call Perinatal HIV Hotline at 1-800-439-4079)

Patient is Known HIV-Positive (HIV diagnosed prior to L&D)

If unable to obtain documentation of known HIV-positive status, must recommend a rapid HIV test

Follow Best Practices for HIV-Positive Women in Labor

  • Consider cesarean delivery if viral load thought to be >1000 copies/mL
  • Expedite labor if rupture of membranes has occurred
  • Try to avoid invasive procedures (i.e. internal monitors, AROM, operative delivery) in labor
  • Early bath for infant in DR/cleanse skin before any injection

AND

See Best Practices for Care of HIV-Exposed Infants

  • Start AZT syrup for newborn ASAP after delivery
  • Consult Perinatal HIV Hotline at 1-800-439-4079 for infants at high-risk who will require additional antiretrovirals. See here for high-risk criteria.

Patient is Preliminarily HIV-Positive (Positive rapid HIV test)

Ensure blood has been sent for confirmatory HIV testing

See Rapid HIV Testing Materials for IL Hospitals and discuss the following with the patient:

  • Preliminary positive result; need to confirm result with a test that may take a few days
  • Importance of starting AZT immediately until delivery to prevent transmission to infant
  • No breastfeeding (pump & dump until HIV status confirmed)

Counsel patient to sign Hotline Release of Information Form for follow-up assistance including enhanced case management; fax signed form to Hotline at 312-472-0978.

Prior to Discharge:

  • Ensure mother will be discharged with a 2-week supply of AZT syrup for newborn
  • Consult Infectious Disease and Social Work
  • Arrange referral for adult HIV care for mother and pediatric HIV care for infant, and confirm linkage. The Perinatal HIV Hotline can assist with linkage to care.

If Preliminary Positive Rapid HIV Test on Mother or Infant:

  • Set plan for informing patient of confirmatory HIV test result
  • Report, as mandated by state law, to 24/7 Illinois Perinatal HIV Hotline at 1-800-439-4079 within 24 hours.
  • Complete Preliminary Positive Data Report Form and fax to 312-334-0973

See Perinatal HIV Reporting Requirements to complete reporting for Illinois Department of Public Health:

*** It is the attending physician’s responsibility to ensure patient is informed of confirmatory test results, that linkage to care occurs, and that infant is discharged with appropriate AZT. The 24/7 Illinois Perinatal HIV Hotline can be called to assist with follow-up***