30th June 2023

Infections

Women in the UK are screened for HIV, hepatitis B and syphilis. They are also asked about smear test history and HPV infection, herpes simplex and whether they have a positive history of chickenpox infection.

Hepatitis B infection should be managed as outside pregnancy; viral load guides whether the baby requires early hepatitis B vaccine or, rarely, immunoglobulin after delivery.

HIV

Most women with HIV are aware of their diagnosis prior to pregnancy. When they are on effective combination antiretroviral therapy (cART), this should be continued; if dolutegravir is included in the regimen, high dose folic acid is required to reduce the risk of neural tube defects. All pregnant women, including elite controllers, should start cART and be encouraged to continue this after pregnancy.

Viral load in the later stages of pregnancy will guide discussions about the mode of delivery. For women on cART with a viral load <50 HIV RNA copies/mL at 36/40, caesarean section should be offered for obstetric reasons only. External cephalic version and amniocentesis/chronic villous sampling are also appropriate with a non-detectable viral load.

Neonatal management in the very low risk setting is zidovudine monotherapy.