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system of clear referral paths should be established in each unit or department so that pregnant women who are diagnosed with an HIV infection are managed and treated by the appropriate specialist teams. 1 The Department of Health 2 has pro- duced guidelines for the management of HIV screening during pregnancy and the following information is taken from this report.
Most HIV infected children in this country have acquired the infection from their mothers. There are now interventions that can reduce the risk of mother-to-child transmission of HIV from 25% to 2%. In order to take advantage of these it is vital to diagnose the infection before birth.
HIV prevalence varies across the UK but antenatal screening and the chance to offer treatment to affected women remains a cost-effective screening strategy.
Information about the test is given to the woman during the booking
interview. Pre- and post-test counselling should be offered. The nature of the test and how she will receive the results is explained.
The implications of a positive result need to be explored. The woman is informed personally if the result is positive and she will be offered specialist counselling and support which is available for partners and family if requested.
Women found to be positive are referred for specialist HIV treatment and advice about how to manage their own infection and interventions to reduce the risk of vertical and sexual transmission.
Discussions cover the use of anti-retrovirals and caesarean section, early treatment and care for the child, and decisions about breastfeeding.
The implications of a negative result and general sexual health are discussed. This is also an opportunity to discuss the dangers of becoming infected during pregnancy or lactation.
Women who refuse an HIV test at booking should be re-offered a test, and should they decline again a third offer of a test should be made at 36 weeks. Women presenting to services for the first time in labour should be offered a point of care test (POCT). 3 A POCT test may also
be considered for the infant of a woman who refuses testing antenatally. 3
In areas of higher seroprevalence, or where there are other risk factors, women who are HIV negative at booking may be offered a routine second test at 34–36 weeks’ gestation as recommended in the British HIV Association (BHIVA) pregnancy guidelines. 4
National Institute for Health and Clinical Excellence (2008). Antenatal care: Routine care for the healthy pregnant mother. Clinical guideline 62. London: NICE. Available at: M www.nice.org. uk/cg62.
Department of Health (2003). Screening for infectious diseases in pregnancy: Standards to support the UK Antenatal Screening Programme. Available at: M www.dh.gov.uk (3.5.10).
Department of Health (2008). UK National Guidelines for HIV testing. London: DH.
British HIV Association (2008). Management of HIV infection in pregnant women. Available at: www.bhiva.org/PregnantWomen2008.aspx (accessed 3.5.10).
CHAPTER 4 Antenatal care
60
The full blood count
A full blood count (FBC) obtained in the first trimester acts as a baseline against which all other measurements can be compared.
A FBC should be repeated at 28 weeks’ gestation to allow for correction of anaemia prior to term.
As pregnancy progresses, plasma volume expansion is greater than the corresponding rise in the red cell count, this leads to a haemodilution effect and the haematocrit falls, along with the haemoglobin (Hb) level. This is called physiological anaemia.
Apparent anaemia can be a sign of an excellent adaptation to pregnancy. The effect is greatest at around 30–32 weeks’ gestation.
Lower mean Hb concentrations are associated with higher mean birth- weights, and higher mean Hb concentrations are associated with an increase in pre-term delivery and low birth-weight babies.
Hb levels outside the normal UK range for pregnancy should be investigated and iron supplementation considered if indicated.
The levels are 11g/dL
Most HIV infected children in this country have acquired the infection from their mothers. There are now interventions that can reduce the risk of mother-to-child transmission of HIV from 25% to 2%. In order to take advantage of these it is vital to diagnose the infection before birth.
HIV prevalence varies across the UK but antenatal screening and the chance to offer treatment to affected women remains a cost-effective screening strategy.
Information about the test is given to the woman during the booking
interview. Pre- and post-test counselling should be offered. The nature of the test and how she will receive the results is explained.
The implications of a positive result need to be explored. The woman is informed personally if the result is positive and she will be offered specialist counselling and support which is available for partners and family if requested.
Women found to be positive are referred for specialist HIV treatment and advice about how to manage their own infection and interventions to reduce the risk of vertical and sexual transmission.
Discussions cover the use of anti-retrovirals and caesarean section, early treatment and care for the child, and decisions about breastfeeding.
The implications of a negative result and general sexual health are discussed. This is also an opportunity to discuss the dangers of becoming infected during pregnancy or lactation.
Women who refuse an HIV test at booking should be re-offered a test, and should they decline again a third offer of a test should be made at 36 weeks. Women presenting to services for the first time in labour should be offered a point of care test (POCT). 3 A POCT test may also
be considered for the infant of a woman who refuses testing antenatally. 3
In areas of higher seroprevalence, or where there are other risk factors, women who are HIV negative at booking may be offered a routine second test at 34–36 weeks’ gestation as recommended in the British HIV Association (BHIVA) pregnancy guidelines. 4
National Institute for Health and Clinical Excellence (2008). Antenatal care: Routine care for the healthy pregnant mother. Clinical guideline 62. London: NICE. Available at: M www.nice.org. uk/cg62.
Department of Health (2003). Screening for infectious diseases in pregnancy: Standards to support the UK Antenatal Screening Programme. Available at: M www.dh.gov.uk (3.5.10).
Department of Health (2008). UK National Guidelines for HIV testing. London: DH.
British HIV Association (2008). Management of HIV infection in pregnant women. Available at: www.bhiva.org/PregnantWomen2008.aspx (accessed 3.5.10).
CHAPTER 4 Antenatal care
60
The full blood count
A full blood count (FBC) obtained in the first trimester acts as a baseline against which all other measurements can be compared.
A FBC should be repeated at 28 weeks’ gestation to allow for correction of anaemia prior to term.
As pregnancy progresses, plasma volume expansion is greater than the corresponding rise in the red cell count, this leads to a haemodilution effect and the haematocrit falls, along with the haemoglobin (Hb) level. This is called physiological anaemia.
Apparent anaemia can be a sign of an excellent adaptation to pregnancy. The effect is greatest at around 30–32 weeks’ gestation.
Lower mean Hb concentrations are associated with higher mean birth- weights, and higher mean Hb concentrations are associated with an increase in pre-term delivery and low birth-weight babies.
Hb levels outside the normal UK range for pregnancy should be investigated and iron supplementation considered if indicated.
The levels are 11g/dL
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