Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Intrapartum Care

Other Intrapartum Management Considerations

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Panel's Recommendations Regarding Other Intrapartum Management Considerations
Panel's Recommendations
  • Artificial rupture of membranes (ROM) can be performed for standard obstetric indications in virologically suppressed women with HIV who are on antiretroviral therapy (ART) (BII).
  • The following procedures should generally be avoided because of a potential increased risk of HIV perinatal transmission, unless there are clear obstetric indications:
    • Artificial ROM in the setting of viremia (BIII)
    • Routine use of fetal scalp electrodes for fetal monitoring (BIII)
    • Operative delivery with forceps or a vacuum extractor (BIII)
  • The ART regimen a woman is receiving should be taken into consideration when treating excessive postpartum bleeding resulting from uterine atony:
    • In women who are receiving a cytochrome P450 (CYP) 3A4 enzyme inhibitor (e.g., a protease inhibitor, integrase inhibitor, cobicistat), methergine should be used only if no alternative treatments for postpartum hemorrhage are available and the need for pharmacologic treatment outweighs the risks. If methergine is used, it should be administered at the lowest effective dose for the shortest possible duration (BIII).
    • In women who are receiving a CYP3A4 enzyme inducer such as nevirapine, efavirenz, or etravirine, additional uterotonic agents may be needed because of the potential for decreased methergine levels and inadequate treatment effect (BIII).
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion

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