The management of the pregnancy and newborn of a woman living with HIV should involve adult ID or GUM services, paediatric and neonatal services as well as obstetrics, midwifery and pharmacy. The objectives of a health pregnancy and minimising the risk of transmission of the virus to the baby can be achieved through good communication and team working both within health boards and occasionally across Scotland and beyond.
In Scotland the large majority of these pregnancies occur in either the NHS Lothian or NHS Greater Glasgow & Clyde Health Boards and the teams in these health boards represent a significant resource for other teams in Scotland who will be less experienced.
The perinatal integrated care pathway (ICP) is designed to help clinicians deliver optimal multidisciplinary care to these women and babies through a series of checklists at four key time points during pregnancy. The checklists can either be printed off and filed in notes or filed electronically and saved (but please note these are frequently reviewed and it is your responsibility to ensure you are using the most current version)). The ICP is designed to be flexible and fit in with current methods of working. It does not replace existing national guidance, British HIV Association Guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update), nor local protocols but allows for the structuring of local care to mirror best practice. It is suggested that a designated member of the local team (e.g. specialist nurse or midwife) take responsibility for completion of the checklists and bringing to the attention of the wider multidisciplinary team any issues that need addressing. There will be certain points in the management of some pregnancies where teams with less experience may want to consult the NHS Lothian or NHS Greater Glasgow & Clyde Team for further advice and these have been highlighted in the checklists. A downloadable checklist for late bookers has also been included as a suggested draft birth plan.
Booking Checklist
20 Weeks Checklist
36 Weeks Checklist
Delivery Checklist
Late Presenter Checklist
If you have any queries or concerns, please contact mailto:nss.spaiin@nhs.scot. Please do not send SPAIIN patient identifiable information.
Guideline Disclaimer:
These guidelines do not intended to be construed or to serve as a standard of care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement must be made by the appropriate healthcare professional(s) responsible for clinical decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived at following discussion of the options with the patient, covering the diagnostic and treatment choices available. It is advised, however, that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken.