Question

Which intervention would reduce the risk of perinatal transmission via vaginal birth in an adolescent who is diagnosed with HIV infection?

Using forceps during delivery

Using a fetal scalp electrode during delivery

Using antiretroviral during the intrapartum period

Administering zidovudine an hour before labor

Answer 1

Correct answer : Using antiretroviral during intrapartum period

All women testing posting for HIV should be started on continuous intravenous (IV) Infusion of zidovudine(ZDV) in labour to
prevent perinatal transmission of HIV. Although intrapartum Antiretroviral medications will not prevent
Vertical transmission that has occured before labor, most transmission occurs near to or during labor and
delivery. Pre-exposure prophylaxis can be provided for the fetus by giving mothers a drug that rapidly
crosses the placenta. This produces systemic ARV drug levels in the fetus before the fetus is exposed to HIV in maternal genital secretions and blood during birth. In general, Zidovudine and other
nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and the integrase strand transfer inhibitor (INSTI) raltegravir cross the placenta well, whereas protease inhibitors do not.

Dosage : intravenous zidovudine 2mg/kg bodyweight initial dose in one hour followed by 1mg/kg/hour continous infusion until delivery

Usage of Forceps and Foetal scalp electrode are known to rather increase the chances of HIV transmission and are to be avoided.

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