How should staff manage a patient who presents to labor and delivery with no prenatal care?

Any woman who presents to labor and delivery without prenatal care should be offered and recommended rapid HIV testing. Women with a preliminary positive rapid HIV test who are in active labor should be counseled on the test result, the risk of vertical transmission and the potential benefit of a cesarean delivery in reducing that risk. The mother should receive appropriate treatment for an HIV-infected woman in labor until confirmatory tests prove otherwise.

Intravenous AZT should be initiated immediately and blood sent for a subsequent supplemental HIV test to confirm the positive rapid HIV result. The neonate should also be managed as though the mother is positive until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices for HIV+ Women in Labor including those with a positive rapid HIV test.

If the woman is not in labor, and delivery is not imminent, confirmatory testing should be conducted and the patient managed accordingly. Expedited confirmatory HIV testing is available through the Illinois Perinatal HIV Hotline with results generally obtained within 24 hours. Please call 1-800-439-4079 for additional information or specific questions.