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

Any patient who presents to labor and delivery without prenatal care should be offered and recommended rapid HIV testing. People 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 patient should receive treatment appropriate for HIV in a laboring patient, until confirmatory tests prove otherwise.

Intravenous Zidovudine (AZT) should be initiated immediately and blood sent for a supplemental HIV test to confirm the positive rapid HIV result. The neonate should also be managed as though the birthing parent is positive until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care for Infants with Perinatal Exposure to HIV including those with a positive rapid HIV test.

If the patient 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.