CDC Recommendations for Antenatal HIV Surveillance and Care - 2000

Perform standard prenatal baseline laboratory tests and Papanicolaou smears, plus CD4 counts, toxoplasmosis and cytomegalovirus titers, liver enzyme levels, a tuberculin test (purified protein \derivative) and a glucose-6-phosphate dehydrogenase (G6PD) level.
Offer zidovudine (Retrovir) prophylaxis according to the guidelines formulated by the Centers for Disease Control and Prevention
Consider antenatal influenza, pneumococcal and hepatitis B immunizations (may wait until after the first trimester).
Perform a complete physical examination and a review of systems during each trimester.
Maintain surveillance for HIV-related opportunistic infections based on CD4 staging; initiate prophylaxis as indicated.
Repeat sexually transmitted disease screening tests (rapid plasmin reagin test/VDRL test, gonorrhea culture and Chlamydia assay) and group B streptococcal culture in the third trimesters.
If the pregnant woman is receiving zidovudine therapy, monitor the complete blood count and liver enzyme levels each month.
Obtain a CD4 count each trimester if the count is under 600 per uL; repeat the CD4 count at six weeksand six months postpartum.
Discuss postpartum contraception and safe sexual practices.

Minimize internal fetal monitoring and fetal scalp sampling; fetal scalp lesions increase the risk ofexposure to maternal blood.
Wear double gloves and eye shields to protect against exposure to body fluids.
Avoid episiotomy, vacuum extraction and the use of forceps.
At this time, cesarean sections have no specific HIV-related indications.
To avoid needle sticks, repair of all lacerations and episiotomies should be performed by the most experienced personnel available.

Counsel the mother about the proper disposal of sanitary pads and the need for careful hand washing before she handles the infant.
Circumcision is not specifically contraindicated.
Breast feeding should be discouraged in developed countries.
Provide routine postpartum and HIV-related care to the mother as indicated.
The child may require referral to a specialist familiar with the care of infants at risk for HIV infection.