nursing and midwifery - text

Results

Every hospital should have local policies but the following provides some guiding principles for the management of results.

Negative results

  • Informed at next hospital visit 

 

Unconfirmed reactive results

  • Laboratory will telephone the lead midwife to request a second blood sample, also requested on hard copy report 
  • Woman is recalled and an explanation given that occasionally there is a slight reaction within the HIV test which in almost all cases does not indicate HIV infection but that a retest is required
  • Repeat blood sample 

 

Positive results

  • The laboratory will contact the woman’s consultant/lead midwife and inform them of a positive result, requesting a second sample to confirm identity 
  • Ideally, arrangements should be made for a member of the GUM/HIV team to be present when initial diagnosis is given by an appropriate member of the obstetric team. If not possible, an appointment should be given for the GUM/HIV clinic as soon as possible
  • All women to have confirmed positive tests explained in person (avoid Friday or before a public holiday) 
  • The woman should not be overburdened with information at this stage. The focus should be on the positive impact of available treatment and include the following:  
    • The prognosis for her own health and her pregnancy is good 
    • The risk of the baby being infected is, with proper management, very low 
    • That she will be managed by a professional multi disciplinary team who have experience in managing pregnancy affected by HIV

     

    Giving a positive result is challenging for the health professionals involved. Here Jenny talks about her experience as antenatal screening coordinator and breaking bad news. Jenny acknowledges that every woman’s case is different and talks about the emotional impact on the woman and the health professional ...

 

 

Subsequent discussion with the specialist team will cover:

  • HIV effect on pregnancy 
  • Effect of pregnancy on HIV 
  • Prevention of transmission to the child 
  • Confidentiality and informing key health professionals 
  • Partner notification and testing of partner/children 
  • Drug therapy 
  • Family/social support 
  • Obstetric/antenatal care 
  • Mode of delivery 
  • Infant feeding including recommendation of avoidance of breastfeeding 
  • Postnatal care and assessing status of the child

 

Useful link:

NHS Infectious diseases in pregnancy screening programme. Handbook for laboratories (2012)