The UK guidelines

In all scenarios, where the most recent viral load is detectable at more than 50 copies/ml or the viral load is unknown at week 38, pre-labour caesarean section plus intravenous AZT (zidovudine, Retrovir) is recommended. Vaginal delivery may be considered for women on stable therapy with viral loads below 50 copies/ml prior to delivery.¹

• A caesarean delivery is recommended if a woman is taking AZT monotherapy, or if viral load is above 50 copies/ml at the time of delivery.
• A caesarean delivery should be considered for women with hepatitis C co-infection.
• Women taking triple drug antiretroviral therapy with an undetectable viral load have an option of a caesarean delivery.
• Caesarean delivery should be timed for week 38 of pregnancy for women who have a detectable viral load or who are taking AZT monotherapy. For women with an undetectable viral load who are taking triple drug antiretroviral treatment, the caesarean should be timed for week 39.

• An elective vaginal delivery is an option for women taking triple drug antiretroviral therapy who have a viral load below 50 copies/ml at the time of delivery.
• There should be good communication between team members about planning and timing.
• Women should be given written care plans.

• This should be given to women who took AZT monotherapy and to those with a detectable viral load at the time of delivery.

• All HIV-positive women should be tested for these viruses. Women infected with hepatitis B should receive antiretroviral therapy with drugs that are active against both HIV and hepatitis B. Women infected with hepatitis C should be offered triple drug antiretroviral therapy and are recommended to have an elective caesarean delivery.