{"id":470,"date":"2017-04-03T10:27:28","date_gmt":"2017-04-03T09:27:28","guid":{"rendered":"http:\/\/www.mcns.scot.nhs.uk\/spaiin\/?page_id=470"},"modified":"2025-02-25T13:23:44","modified_gmt":"2025-02-25T13:23:44","slug":"healthy-pregnancy-36-weeks","status":"publish","type":"page","link":"https:\/\/www.nn.nhs.scot\/spaiin\/professionals\/guidance\/perinatal-hiv-care-pathway\/healthy-pregnancy-36-weeks\/","title":{"rendered":"36 Weeks Checklist"},"content":{"rendered":"\n<p><a href=\"https:\/\/www.spaiin.scot.nhs.uk\/wp-content\/uploads\/sites\/30\/2024\/02\/NSD610-019.04-SPAIIN-Perinatal-HIV-Care-Pathway-\u2013-36-Weeks-Checklist-V3.docx\" data-type=\"attachment\" data-id=\"1447\">NSD610-019.04 SPAIIN &#8211; Perinatal HIV Care Pathway \u2013 36 Weeks Checklist<\/a><\/p>\n\n\n\n<p>Please download and complete the 36-weeks checklist or print off and complete a paper version.<\/p>\n\n\n\n<p>Obstetric Management<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Delivery Plan<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Review intrapartum\/postpartum management plan for mother and baby.<\/li>\n\n\n\n<li>For women taking ART, a decision regarding recommended mode of delivery should be made after review of plasma HIV PCR results at 36 weeks.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Delivery Plan at 36 Weeks<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>If HIV PCR &lt;50 copies\/mL<\/em><\/strong>&nbsp;\u2013 in the absence of obstetric contraindications, a planned vaginal delivery is recommended.<\/li>\n\n\n\n<li><strong><em>If&nbsp;HIV PCR 50-399 copies\/mL<\/em><\/strong>&nbsp;\u2013 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\u2019s views.<\/li>\n\n\n\n<li><strong><em>If HIV PCR is 400 copies\/mL<\/em><\/strong>&nbsp;\u2013 PLCS is recommended.<\/li>\n\n\n\n<li>Where the indication of PLCS is PMTCT, PLCS should be undertaken at between 38 and 39 weeks\u2019 gestation.<\/li>\n\n\n\n<li>Ensure pharmacy team knows of potential maternal drugs and formulations that may be required.<\/li>\n\n\n\n<li>Notify paediatric department in advance, if planned, on admission if unplanned.<\/li>\n\n\n\n<li>Confirm current maternal HIV medication including dose and frequency.<\/li>\n\n\n\n<li>HIV Management and Prevention of Transmission<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Maternal ART<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Detectable HIV PCR<\/strong>&nbsp;\u2013 if plasma&nbsp;<strong>HIV PCR of &gt;50 copies\/mL<\/strong>&nbsp;at 36 weeks. &nbsp;Review adherence and concomitant medication. &nbsp;Perform resistance test if appropriate. &nbsp;Consider further therapeutic drug monitoring. &nbsp;Optimise to best regimen and consider intensification &#8211; see BHIVA 2018 (2020 third interim update) <a href=\"https:\/\/www.bhiva.org\/file\/5f1aab1ab9aba\/BHIVA-Pregnancy-guidelines-2020-3rd-interim-update.pdf\">Pregnancy Guidelines \u2013 Section 5.2.7:&nbsp; Failure to suppress<\/a><\/li>\n\n\n\n<li><strong>Undetectable HIV PCR<\/strong>&nbsp;\u2013 if plasma&nbsp;<strong>HIV PCR &lt;50 copies\/mL<\/strong>&nbsp;at 36 weeks continue on current ART and check HIV PCR again at delivery.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Neonatal Care Plan<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>PEP<\/strong>&nbsp;\u2013 review neonatal PEP plan and ensure documented in clinical notes with delivery plan &#8211; see BHIVA 2018 (2020 third interim update) <a href=\"https:\/\/www.bhiva.org\/file\/5f1aab1ab9aba\/BHIVA-Pregnancy-guidelines-2020-3rd-interim-update.pdf\">Pregnancy Guidelines \u2013 Section 9.1:&nbsp; Infant PEP<\/a><\/li>\n\n\n\n<li><strong>Infant Feeding<\/strong>&nbsp;\u2013 re-iterate advice over infant feeding. See links in \u201cHealthy Pregnancy \u2013 20 weeks\u201d for further information on infant feeding. Ensure local pathway for accessing support for formula feeding accessible.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p class=\"nhsuk-card__description\">NSD610-019.04 SPAIIN &#8211; Perinatal HIV Care Pathway \u2013 36 Weeks Checklist Please download and complete the 36-weeks checklist or print [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":452,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-470","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/pages\/470","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/comments?post=470"}],"version-history":[{"count":13,"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/pages\/470\/revisions"}],"predecessor-version":[{"id":1595,"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/pages\/470\/revisions\/1595"}],"up":[{"embeddable":true,"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/pages\/452"}],"wp:attachment":[{"href":"https:\/\/www.nn.nhs.scot\/spaiin\/wp-json\/wp\/v2\/media?parent=470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}