Management of HIV,

Hepatitis, and STDs

During Labor
Ensuring the safety of both the mother and child is
paramount when managing HIV, Hepatitis, and STDs
during labor.

Eman Al Maamari
MSN 132173
Outline:

• Management of GDM during labor

• Management of HIV during labor
• Management of Hepatitis B during
labor
 HIV Definition
A virus that attacks the immune system, specifically targeting the CD4 cells, which

are crucial in fighting off infections and diseases. This virus will leads to the

development of AIDS, or Acquired Immunodeficiency Syndrome.

HIV is transmitted through :

Certain body fluids, such as blood, semen, vaginal fluids, and breast milk.

It can be transmitted through unprotected sex, sharing needles, or from mother to

child during childbirth or breastfeeding.

HIV weakens the immune system, making individuals more susceptible to

infections and diseases.

 HIV Transmission During childbirth
Transmission of HIV during labour, During childbirth, if a mother is infected with

HIV, there is a risk of transmission to the baby. This can occur when the baby

comes into contact with the mother's blood or vaginal fluids. However, the risk of

transmission can be significantly reduced with the use of antiretroviral

medications during pregnancy, labor, and breastfeeding. Additionally, healthcare

professionals can take precautions, such as performing a cesarean section or using

antiretroviral drugs on the baby after birth, to further minimize the risk of

transmission.
 Addressing HIV during labour
The importance of addressing HIV during labour
• By addressing HIV during labour, healthcare professionals can greatly
contribute to the overall prevention and control of HIV transmission in
newborns.
• It allows healthcare providers to closely monitor the mother's viral load.
• and administer necessary medications to reduce the risk of transmission to the
baby.
• Regular HIV testing during pregnancy also ensures early detection and timely
intervention, increasing the chances of a healthy outcome for both the mother
and the baby.
Prevention of Mother-to-Child Transmission (PMTCT)

PMTCT strategies include implementing :

1. Antiretroviral treatment for pregnant women living with HIV,

2. providing them with counseling and support services,

3. and offering HIV testing to their partners.

These interventions aim to reduce the viral load in the mother and suppress the

virus, thus minimizing the risk of transmission to the baby during pregnancy, and

childbirth.
 Antiretroviral Treatment

• IV zidovudine 2mg/kg(total body weight) over1 hour, followed by a

continuous IV of 1mg/kg/hour until clamping of umbilical cord

• Women should be given cabergoline to suppress lactation

• Guidance for contraception in the immediate postpartum period

 Intrapartum care

• Zidovudine is given IV infusion starting at the onset of labor (vaginal delivery) or 4 hours

before cesarean section. Loading dose 2mg/kg, maintenance dose 1mg/kg/hr until cord

clamping is done.

• A single dose of Nevirapine at the onset of labor and a single dose of it to the newborn at age

48 hours is an effective alternative requirement for women who had no prior therapy.
 To AVOID :

• Mother-to-child transmission is increased where membranes

are ruptured for more than four hours. Artificial rupture of
membranes should not be undertaken if progress of labour is
adequate.
• Episiotomy should not be performed routinely, but reserved for
those cases with an obstetrical indication.
• Avoid any instrumental delivery.
 Newborn care:

• Cord should be clamped as early as possible after delivery and the baby should be

bathed immediately after birth. Baby’s face and eyes are cleaned at delivery,

• NO breast feeding, Breastfeeding is substituted with formula milk.

• All infants born to women who are HIV positive should be treated with

antiretroviral therapy from birth for 4–6 weeks.

• PCR is used for the diagnosis of infant infection, typically, tests are carried out at

birth, then at 3 weeks, 6 weeks and six months.

 Postpartum care
 Zidovudine syrup-2mg/kg is given to the neonate 4
times daily for first 6 weeks of life. High risk neonate
should be treated with HAART. The infant is tested at
D1, weeks 6, 12 and at 18months of age.
 Pregnant with HIV
Taking HIV treatment as prescribed to stay healthy, protect the partner, and protect the baby.
HIV treatment reduces the amount of HIV in the body (viral load) to a very low level. This is
called viral suppression or an undetectable viral load.
Getting and keeping an undetectable viral load is the best thing can do to stay healthy and prevent
transmission to baby.
The risk of transmitting HIV to baby can be 1% or less if :
Taking HIV treatment as prescribed throughout pregnancy and delivery.
Give HIV medicines to baby for 2 to 6 weeks after birth.

If HIV viral load is not low enough, a cesarean delivery can help prevent HIV
transmission.

The only option that eliminates risk of postnatal transmission of HIV to the baby is infant formula
MOVING TO HEP B
Hepatitis B Infection

It’s an a inflammation of the liver

The liver is a large, solid organ located in the right upper quadrant of the

abdomen, which has several functions, including the production of bile,

cholesterol, and certain blood proteins like albumin and clotting factors.

The liver is also involved in helping with glucose, fat, and bilirubin

metabolism.
Hepatitis B Infection

Hepatitis B virus is primarily transmitted through blood and other body

fluids; so the main risk factors include blood transfusions, hemodialysis,

IV drug use, working as a healthcare professional, as well as high-risk

sexual behavior, such as having multiple partners or not using

protection.

can also be transmitted from the mother to the baby.

Hepatitis B Infection

Transmitted from the mother to the baby.

This can happen as the virus travels 1. across the placenta; during

invasive procedures like amniocentesis or chorionic villus sampling; if

the amniotic membranes rupture prematurely; and 2. During labor, as

the newborn passes through the birth canal.

Hepatitis B Infection

Clinical manifestations of HBV infection during pregnancy include:

fatigue, malaise, nausea, and vomiting. Additionally, clients can present

with a low-grade fever, jaundice, skin rash, itching, particularly on the

palms and soles of the feet, as well as dark urine. They may also have

right upper quadrant tenderness, as well as hepatomegaly.

 Hepatitis B Infection
Screening:
Universal antenatal screening for hepatitis B surface antigen (HBsAg): Recommended for all pregnant
women at first contact with antenatal services.
Repeat screening in the third trimester for high-risk groups: Women with risk factors like HBV
prevalence in their country, family history of HBV, or positive HBsAg in a previous pregnancy.

Tests:

Hepatitis B surface antigen (HBsAg): Detects active infection.

Hepatitis B core antibody (HBcAb): Indicates past or current infection.

Hepatitis B surface antibody (HBsAb): Indicates immunity from vaccination.

Hepatitis B viral load: Determines the degree of viral activity and risk of transmission.
 Hepatitis B Infection
Interpretation of Results:

Positive HBsAg: Indicates active infection and potential risk of transmission to

the baby.

Positive HBcAb alone: May indicate past or current infection without active

replication.

Positive HBsAb without other markers: Indicates immunity from vaccination or

previous infection.

High viral load: Increases the risk of mother-to-child transmission.

Hepatitis B Infection
Treatment during Pregnancy:

Goal: Minimize viral replication and reduce the risk of mother-to-child transmission.

Antiviral medication:

Tenofovir disoproxil fumarate (TDF): Preferred drug due to its safety profile and effectiveness.

Cesarean section: May be recommended in some cases with high viral load to further reduce the risk of

transmission, especially during prolonged rupture of membranes.

Close monitoring: Regular assessments of maternal health, viral load, and potential side effects of medication are

essential.

Individualized approach: Treatment decisions consider viral load, liver health, gestational age, and potential

maternal factors.
Minimize Invasive Procedures:

Routine episiotomy: Avoid routine episiotomy, as it can create additional entry points for potential

viral transmission. Only perform an episiotomy if medically necessary for fetal or maternal safety.

Excessive vaginal examinations: Limit the number of vaginal examinations during labor to decrease

the risk of mucosal tears and potential exposure. Use alternative monitoring methods when possible.

Instrumental delivery: Avoid unnecessary use of instruments like forceps or vacuum extraction, as

they can increase the risk of trauma and viral transmission. Consider these interventions only when

medically necessary for safe delivery.

Newborn:

• A combination of hepatitis B immunoglobulin and hepatitis B

vaccine to be given for baby after bath.

• The active vaccine is given in three doses: at birth, at one month

and at six months of age.

• Close observation of newborn: Monitoring for signs of neonatal

infection in the first few days and weeks of life.

 Postnatal Care:

• Continue antiviral medication: Breastfeeding mothers on TDF can safely

breastfeed while their babies receive HBIG and the vaccination series.

• Complete infant vaccination series: Timely adherence to the recommended

hepatitis B vaccine schedule for long-term protection.

• **Long-term ** Regular monitoring of both mother and baby for potential

complications and ongoing management of maternal hepatitis B.

 • Recommendations:
• Partner notification and testing: Encourage the mother's partner to get tested

and vaccinated can further reduce the risk of transmission within the family.

• Psychological support: Addressing the emotional concerns and anxieties

associated with living with hepatitis B during pregnancy and motherhood is

crucial.

• Community education and awareness: Breaking down stigma and promoting

understanding of hepatitis B can improve access to care and support for

families affected by the virus.