Intrapartum Management for Prevention of Mother-To-Child Transmission of HIV in Resource-Limited Settings: A Review of the Literature

K. Cherry Liu, Carla J. Chibwesha

Abstract

Prevention of mother-to-child transmission (PMTCT) of HIV guidelines in resource-limited settings focus on antenatal and postnatal management. In this review of the literature, we present findings from select studies, highlight best practices, and present evidence-based guidelines for intrapartum PMTCT management that are applicable to resource-limited settings. We discuss the roles of intrapartum HIV testing, intrapartum antiretroviral medications, mode of delivery in settings with and without HIV RNA testing, other delivery practices, and infant care in the immediate postnatal period. With the advent of Option B+, which recommends all HIV-infected pregnant women commence lifelong combination antiretroviral therapy (ART), the potential impact for intrapartum interventions will be greatest for those women who recently have seroconverted and those with unknown HIV status. Research on intrapartum PMTCT interventions should focus on these populations. Afr J Reprod Health 2013 (Special Edition); 17[4]: 107-117).

 

Keywords: labor and delivery, pregnancy, PMTCT  

 

Résumé

 

La prévention de la transmission du virus VIH de la mère à l'enfant (PTME)  dans les lignes directrices dans les milieux à ressources limitées met l’accent sur la gestion prénatale et postnatale. Dans cette revue de la documentation, nous présentons les résultats de certaines études, les meilleures pratiques ainsi que  les lignes directrices fondées sur des preuves pour la gestion de  la PTME de l’intrapartum qui sont applicables aux pays à ressources limitées. Nous discutons le rôle du dépistage du VIH pendant l'accouchement,  les  médicaments antirétroviraux de l’intrapartum, le mode de prestation dans des milieux avec et sans dépistage de l'ARN du VIH, d'autres pratiques d'accouchement et les soins aux nourrissons pendant la période postnatale immédiate. Avec l'avènement de l'option B +, qui recommande à toutes les femmes enceintes infectées par le VIH commencent la poly thérapie antirétrovirale continue (TAR), l'impact potentiel des interventions pendant l'accouchement sera plus grand pour les femmes qui ont récemment présenté une séroconversion et ceux dont l’état du VIH est inconnu. La recherche sur les interventions de PTME intrapartum devrait se concentrer sur ces populations. Afr J Reprod Health 2013 (Special Edition); 17[4]: 107-117).


 

Mots-clés: travail et accouchement,  grossesse,  PTME

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References

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