HIV IN PREGNANCY

BY:NIHARIKA SHARMA
PG1 OBS AND GYNAE
 I’m presenting a case of Mrs. Komal, a 29 year old female belonging
to Hindu religion, resident of F-93 okhla phase 1 New Delhi,
Housewife by occupation. She is married to Mr. Gaurav for 3 years,
who is a Gym trainer by occupation. According to modified
Kuppuswamy classification, they belong to upper middle class.

 She is primigravida. Her LMP – 25/11/2021,

making her EDD:01/09/2022

 POG is 27 weeks 6 days

 She is a booked patient, presented to HAHC antenatal OPD
for routine antenatal visits as advised by the doctors. She had
a total of 6 visits in her antenatal period till now.

 1st ANC visit on 02/02/2022(at POG of 9 weeks 6 days)

 At 1st ANC visit patient was a k/c/o HIV and was on anti
retroviral therapy.
 Her CD4 counts were 1004 cells/microL and viral showed:no
target detected.
 1st TRIMESTER
 Her pregnancy was spontaneous, which was confirmed by herself with
the help of UPT on 01/01/2022(5 weeks) i.e. 6 days after due date of her
menstrual period. She presented for the first time at 2 months. She had a
total of 2 antenatal visits in 1st trimester.
 Nausea / vomiting was present
 Drug intake history:
Folic acid supplementation was taken
Patient was also taking Anti retroviral therapy(ART) since 2010,which
she continued in pregnancy
(1 tablet OD which has “Dolutegravir:50 mg+Tenofovir:300
mg+Lamivudine:300 mg”)
 Patient got her CD4 counts done in 3rd month
 USG NT/NB (3rd Month) was done which was normal according to the
patient
 All ANC investigations were done. As told by the patient, she was HIV
positive and all other tests were within normal limit.
 Patient had c/o acne which were distributed over her face,neck and
chest,for which she did not take any medicine and were resolved on its
own
 Patient had no signs and symptoms of Kochs or STD
 Patient is cohabitating with her husband only
 No h/o radiation exposure or fever with rash.
 No h/o increase in urinary frequency
 No h/o Bleeding pv.
 2nd TRIMESTER
 H/o Quickening present at 5th month
 Iron and Calcium supplements were taken
 ART continued(1 tablet 24 hourly)
 Patient had c/o B/L flank pain since 5-6 days
increased frequency of micturition since 2 days and fever since 1 day at 21 weeks
 Her pain was gradual in onset,dull in nature, non progressive and non radiating and
had no aggravating/relieving factor
 Patient also had c/o fever (2 episodes) which were associated with body ache,not
associated with chills and rigor,and was relieved on taking medication
 Patient was investigated for the above symptoms and her urine R/M and urine C/S
were done which showed growth which was then treated aggressively with
antibiotics.
 TT injection taken – Received 1st dose in 5TH month
 Usg Level II was done at 5th month and the results were within normal limits
acc to the patient
 OGTT:Not yet done
 Total of 4 visits in 2nd Trimester.
 No h/o headache, blurring of vision, epigastric pain.
 MENSTRUAL HISTORY

 Attained Menarche at 14 years of age

 LMP – 25/11/2021
 Her menses were irregular, 35-45 days cycles, lasting for 3-4 days, uses 2-3
pads per day.
 No h/o Dysmenorrhea/ passage of clots
 OBSTRETICS HISTORY
 Married for 6 years.
 Non – consanguinous marriage
 Husband is HIV negative and are having safe sex practices
 H/o Barrier contraceptive use present.
 She is a primigravida.
 PAST HISTORY
 PAST MEDICAL HISTORY:
 In 2010:When Patient was 18-19 years old,she had c/o recurrent spikes of
fever and weight loss,for which she visited a hospital ,where she got herself
investigated and was diagnosed to be HIV positive : Patient was then started
on anti retroviral therapy since 2010
 Patient also has h/o PCOS since 2020 for which she was undergoing
treatment before pregnancy.
 Patient had also undergone follicular monitoring USG:2 times
 No history of type 2 dm/hypertension/asthma/thyroid
illness/cardiac illness/epilepsy
 No history of blood transfusion/multiple sexual partners/any drug
abuse
 No h/o any abnormal pigmentation,skin lesions
 No h/o
 PAST SURGICAL HISTORY: No previous surgical history
 FAMILY HISTORY: Patient’s mother is having bronchial
asthma
PERSONAL HISTORY

 Mixed Diet
 No sleep disturbances.
 Bowel and Bladder normal
 No h/o substance abuse
 No allergy
 DIETARY HISTORY
 Breakfast – One cup Black tea, Omelet (2 eggs) – 75 +320 = 395Kcal
 Around 11am – Fruits – 180Kcal
 Lunch – Rice, boiled veg + Dal – 170 + 160 + 200 = 530
 4pm – Snacks + Tea – 200 + 80 = 280Kcal
 6pm – Fruits – 180-200 Kcal
 Dinner – Rice, chicken / fish, dal – 170 + 250 + 180 = 600
 Total Calories – 2185kcal, Total Proteins – approx 53 g
 Protein Required - 65g
 Deficit – 12 g (Protein) and approx 200-300kcal
 SOCIOECONOMIC STATUS

 Patients lives in a Pakka house in okhla.

 It is a 2 BHK, with a attached washroom and kitchen, with clean drinking
water facility.
 Ventilation is adequate.
 Husband is a gym trainer by profession and earns approx Rs 30,000 per
month.
 Belongs to Upper Middle Class by Modified Kuppuswamy Classification.
GENERAL EXAMINATION

 Patient was sitting comfortably.

 She was alert, conscious and well oriented to time, place and
person.
 She was adequately built and well nourished.
 Her pre pregnancy weight:52 kg , height – 162.5cm
 BMI – 19.7kg/m2 (Acc to pre pregnancy weight)
 Afebrile
 Pulse – 86 beats/ min
 BP – 112/ 70mmHg taken in right brachial artery in sitting position
 Respiratory rate - 18 breaths/ min
 No s/o Pallor, icterus, cyanosis, clubbing, lymphadenopathy or edema
 HEAD TO TOE EXAMINATION

 Skin and Hair – NAD

 Hydration – adequate hydration
 Lips, Tongue, teeth, gums – NAD
 Neck – NAD
 Lymph nodes – NAD
 Breast – B/L soft
 Hands - nad
 Legs - nad
 Hernial sites normal
SYSTEMIC EXAMINATION

 CNS – conscious, alert, well oriented to time, place and person

 CVS – S1 S2 heard. No murmur heard
 RS – B/L equal air entry
OBSTRETICS EXAMINATION

 INSPECTION – Abdomen is longitudinally ovoid

 Umbilicus is centrally located and is everted
 Linea nigra and stria gravidarum +
 Hernial orifices normal
 No visible pulsations
 PALPATION -
 Symphysio fundal height - approx 24 inches
 Uterus:24-26 weeks
 Abdomen relaxed.
 Liquor seems to be adequate

 AUSCULTATION – FHR heard over the left spino – umbilical line. It was
142 beats per min, regular.
HIV REACTIVE
RPR,HBSAG,ANTI HCV NR
BLOOD GROUP O POSITIVE
LFT/KFT(14/02/2022) WNL
HB(14/02/2022) 14.9 GM/DL
PLATELET 2.5 LAKH/CU.MM
TLC 11400 /CU.MM
CD4 COUNT(05/01/2022) 1004 CELLS/ML
URINE R/M:(22/04/2022)PC: 4-6 /HPF
EC: 28-30/HPF
RBC: NIL
DIAGNOSIS

 A 29 year old primigravida, at 27 weeks 6 days with HIV in

pregnancy with live fetus with viral load test showing target not
detected .