The care of HIV infected women during antenatal period, labor and delivery and the postpartum period includes intensive counseling and voluntary testing (both pre- and post-), screening/obstetric interventions, laboratory investigations, treatment and prophylaxis.

a) The antenatal care of a women identified to be HIV positive is summarized in table 5.2

b) Intrapartum care

Due to the HIV/AIDS Pandemic, modification of routine care during the Intrapartum period is necessary. As shown in table 5.1, some practices may increase the risk of HIV transmission to the baby having little or no proven obstetric value. Some of these practices include avoiding early rupture of membranes during labor, selective use of episiotomy and sucking of the oral pharynx of the baby while vaginal cleaning with hibitane (chlorhexidine 0.25%) solutions may reduce the risk of puerperal and neonatal sepsis. Elective caesarian section reduces the risk of MTCT of HIV infection as shown in table 5.1. However, its use in our setup is debatable. At the same time, proper management of labor using the partogram consistently will reduce the risk of prolonged labor in all women while avoiding invasive procedures.

c) Postpartum and postnatal care

Practices toward reduction of MTCT during the postpartum and postnatal period involve appropriate maternal care and breast care to avoid cracked nipples and mastitis. Ideally, adequate and timely counseling regarding contraception and breast feeding should have been part of the care all through pregnancy and continued during the postpartum and postnatal periods. Overall half of the breast milk transmission takes place by 6 weeks, and three quarters by 6 months after delivery.