36 Weeks Checklist

Document review date February 2025.

NSD610-019.04 SPAIIN – Perinatal HIV Care Pathway – 36 Weeks Checklist

Please download and complete the 36-weeks checklist or print off and complete a paper version.

Obstetric Management

Delivery Plan

  • Review intrapartum/postpartum management plan for mother and baby.
  • For women taking ART, a decision regarding recommended mode of delivery should be made after review of plasma HIV PCR results at 36 weeks.

Delivery Plan at 36 Weeks

  • If HIV PCR <50 copies/mL – in the absence of obstetric contraindications, a planned vaginal delivery is recommended.
  • If HIV PCR 50-399 copies/mL – Pre-labour CS (PLCS) should be considered, taking into account the actual HIV PCR, the trajectory of the HIV PCR, length of time on treatment, adherence issues, obstetric factors and the woman’s views.
  • If HIV PCR is 400 copies/mL – PLCS is recommended.
  • Where the indication of PLCS is PMTCT, PLCS should be undertaken at between 38 and 39 weeks’ gestation.
  • Ensure pharmacy team knows of potential maternal drugs and formulations that may be required.
  • Notify paediatric department in advance, if planned, on admission if unplanned.
  • Confirm current maternal HIV medication including dose and frequency.
  • HIV Management and Prevention of Transmission

Maternal ART

  • Detectable HIV PCR – if plasma HIV PCR of >50 copies/mL at 36 weeks.  Review adherence and concomitant medication.  Perform resistance test if appropriate.  Consider further therapeutic drug monitoring.  Optimise to best regimen and consider intensification – see BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section 5.2.7:  Failure to suppress
  • Undetectable HIV PCR – if plasma HIV PCR <50 copies/mL at 36 weeks continue on current ART and check HIV PCR again at delivery.

Neonatal Care Plan

  • PEP – review neonatal PEP plan and ensure documented in clinical notes with delivery plan – see BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section 9.1:  Infant PEP
  • Infant Feeding – re-iterate advice over infant feeding. See links in “Healthy Pregnancy – 20 weeks” for further information on infant feeding. Ensure local pathway for accessing support for formula feeding accessible.