'''HIV in Pregnancy'''

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Prenatal Care
  1. [***] Obtain HIV Type, Viral Load, Drug-Resistance studies, CD4 count, T. Gondii Serology, CBC, CMP, HepB & HepC panels at time of diagnosis.
  2. [***] All Pregnant women should receive combo-Anti-Retroviral Therapy (cARV/cART), regardless of Viral Load to achieve viral suppression to undetectable levels
Dual NRTI + (NNRTI or PI)
CD4 <350/sick, ASAP
CD4 >350, 14th week
  1. [***] Tdap, Flu shot, Pneumococcal, Hep A/B
  2. [***] If on cARV medication already, likely okay to continue that regimen
  3. [***] CD4 <200, Bactrim for PCP prevention in 2/3 trimester.
  4. [***] Viral Load q3 mos/PRN to assess adherence.
Intrapartum Care
  1. [***] Scheduled C/S if Viral Load is >1000 @ 38 weeks gestation, do not obtain routine amnio.
  2. [***] If viral load is >1000, start IV Zidovudine at 3 hrs before delivery (AZT 2mg / kg IV over 1 hr then AZT 1mg / kg IV til cord clamped)
  3. [***] Continue antepartum home-cARV regimen on schedule during Labor & before scheduled CD
  4. [***] If HIV status unknown at time of labor and delivery & intitial screen is positive, treat with IV Zidovudine until confirmatory test
  5. [***] Avoid AROM, FSE, Episiotomy and Instrument Delivery
  6. [***] If PPH, Methergine is last line @ lowest effective dose
  7. [***] Consider p24 testing, high p24 viremia count suggests increased risk of perinatal transmission (My own $0.02)

Postpartum Care
  1. [***] Don't breastfeed

References =
utdol HIV in Pregnancy
ACOG HIV Pregnancy
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