You will also have the tests and examinations that all pregnant women should have as part of their antenatal care in the UK. These include:. There are some situations where a pregnant woman may be offered a screening test called an amniocentesis. This procedure uses a long, thin needle inserted into the womb to remove some amniotic fluid, the liquid that surrounds the baby, for testing. Because this process involves a needle piercing the skin and going into body tissue, wherever possible, women with HIV should only have an amniocentesis once they are on HIV treatment and have an undetectable viral load.
These drugs can bring your viral load down quickly. Firstly, HIV treatment reduces your viral load so that your baby is exposed to less of the virus while in the womb and during birth. This is also why newborn babies whose mothers are HIV positive are given a short course of anti-HIV drugs this is called infant post-exposure prophylaxis, or infant PEP after they have been born.
When HIV treatment is used during pregnancy, it protects your health as well as preventing HIV being passed on from you to your baby during pregnancy and birth.
Having an undetectable viral load greatly reduces the risk of HIV transmission. While you are pregnant, decisions about your care will sometimes depend on your viral load, and whether or not it is undetectable. As well as reducing the risk of passing HIV on to your baby or to a sexual partner, HIV treatment will strengthen your immune system, reduce the amount of HIV in your body and prevent illnesses from occurring. The sooner you start to take HIV treatment, the sooner you can benefit from it.
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The closer you get to your delivery date, the more important it is to have an undetectable viral load. If you start treatment sooner, you will have more time to bring your viral load down to an undetectable level. If you have a high viral load, your doctor may advise that starting treatment without delay is especially important. However many pregnant women have morning sickness — nausea feeling sick and vomiting being sick — in the first three months of pregnancy.
If you are less than 12 weeks pregnant you could talk to your doctor about waiting to start HIV treatment until you are 13 to 14 weeks pregnant, when morning sickness generally stops. This is because some anti-HIV drugs can also make you feel sick during the first few weeks of treatment. If you do need to start HIV treatment sooner, your doctor can prescribe other medication to deal with sickness, if necessary.
In the past, women who had high CD4 counts sometimes stopped taking HIV treatment after giving birth. If you are already taking HIV treatment, in most cases you can keep taking the same anti-HIV drugs during your pregnancy. This is still the case if you are taking efavirenz Sustiva , also in Atripla.
Previous treatment guidelines recommended that women on efavirenz should change to another drug, as it was thought there may be a connection between efavirenz and birth defects. Some women find that they develop some side-effects from their HIV treatment during pregnancy, such as heartburn, even though they are on the same drugs they have taken for some time.
Talk to your doctor or pharmacist about how best to deal with these side-effects. If you are diagnosed with HIV when you are more than 28 weeks pregnant, you will be advised to start HIV treatment straight away. This is because raltegravir is very effective at reducing viral load quickly. You will also be given a single dose of nevirapine, as well as zidovudine probably intravenously; that is, through a drip throughout your labour and delivery. If you go into labour prematurely before the full term of your pregnancy , a double dose of another drug, tenofovir Viread , may be added to your treatment combination.
If your baby is born very prematurely, they may not be able to absorb HV treatment for the first few days after they are born. The tenofovir provides extra protection for your baby after they are born. Having hepatitis B or hepatitis C as well as HIV can make managing treatment and care during your pregnancy more complicated. Your antenatal care team should work closely with your hepatitis doctor so you get the right treatment and care for your situation.
It will continue to protect your health and lower the risk of passing HIV on to a sexual partner. Some research has shown that adherence levels go down in women after they have had a baby. Discuss any problems you may have taking your treatment with your healthcare team.
They will be able to offer support. Women are often advised to avoid taking medications during pregnancy particularly during the first three months. This is because of the potential risk of drugs interfering with the development of the baby. This is particularly the case if the mother takes a protease inhibitor, and if she is on treatment during the first three months of her pregnancy. However, this is a controversial issue and other evidence suggests that taking anti-HIV drugs does not cause premature delivery.
Your baby will be carefully monitored to ensure he or she is healthy. Information collected about HIV treatment and some abnormalities in babies has not shown an increased risk with any anti-HIV drugs used currently. A birth plan is a written record of your preferences for the birth — including things like where you would like to give birth, what pain relief you would like and who you would like to have with you. It can be helpful to let your antenatal team know whether your birthing partner knows your HIV status, so they can maintain your confidentiality if necessary. For women with HIV, your own health and HIV treatment will be a key factor in your birth plan, as these will affect your choice of delivery.
When you are 36 weeks pregnant, you and your antenatal team can discuss the type of delivery you might have that is, how your baby might be born. Whether or not you have an undetectable viral load will be an important factor in that decision. Ideally, your viral load will be undetectable at 36 weeks of pregnancy. If you are on combination HIV treatment and you have an undetectable viral load at 36 weeks of pregnancy, you can plan to have a vaginal delivery.
The latest evidence shows that having a vaginal delivery does not increase the risk of HIV transmission when a woman has an undetectable viral load. If you have had a caesarean in the past, but you have an undetectable viral load, you can also plan to have a vaginal delivery. This is often called a VBAC — vaginal birth after caesarean.
There may be medical reasons unrelated to HIV that mean it would be safer for you or your baby for you to have a caesarean. Your doctor will look at any non-HIV-related reasons for or against a vaginal delivery, including your views and preferences. There do need to be facilities for testing your baby for HIV and starting him or her on anti-HIV drugs very soon after the birth, wherever your baby is born.
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This makes a vaginal delivery more complicated. A procedure called external cephalic version ECV can be used to turn the baby. It is normally carried out after 36 weeks of pregnancy. However, evidence now shows little or no risk, so these procedures can be used safely if you have an undetectable viral load. If you have been taking zidovudine monotherapy HIV treatment with one drug , you will have a PLCS, even if you have an undetectable viral load. You are likely to have the PLCS at 38 or 39 weeks of pregnancy.
It may be decided that you need a caesarean for another, non-HIV-related reason.
If that is the case, doctors will discuss with you when this should happen. If you have been on zidovudine monotherapy during your pregnancy, you will receive zidovudine during your caesarean section. You can carry on taking it orally by mouth , as you have been doing, or have it intravenously. The baby develops inside a bag of fluid called the amniotic sac. When the baby is ready to be born, the sac breaks and the fluid drains out through the vagina often referred to as the waters breaking. If your waters break before you go into labour, your healthcare team will follow national guidelines on the management of induction and premature labour.
These set out the treatment and care for all women who go into premature labour. If this happens, your baby should be delivered as soon as possible. This is because there is an increased risk of you or your baby developing an infection after your waters have broken. If your viral load was undetectable at your last viral load test, your labour will be induced started artificially immediately. You will be given antibiotic treatment immediately if there is any sign that you are developing an infection.
These include how long you have been on treatment and how well you have been taking it, and whether your viral load has been falling over time. They will also look at any non-HIV-related reasons for or against a vaginal delivery, and talk to you about your views and preferences. If your waters break before you go into labour, and you are between 34 and 37 weeks pregnant, your doctor will follow the same processes, making a decision based on your viral load.
You will also be given antibiotic drugs to prevent your baby getting a bacterial infection called group B streptococcus GBS.
All women who go into labour before they are 38 weeks pregnant are offered this treatment, called GBS prophylaxis. Meanwhile, your doctor will check you about twice a week to make sure your baby is still doing well. You may have one or more of these tests:. If there's a problem with your baby or you still haven't delivered 2 weeks after your due date, your doctor will probably induce labor. Inducing can reduce the chance that you'll need a C-section.