Background: This presentation discusses the management of a multiparous HIV positive patient that was admitted to Baylor University Medical Center’s Labor and Delivery (L&D) with premature rupture of membranes at 28 weeks gestation. A multidisciplinary approach was taken to provide the best care to the maternal-fetal dyad. 

Case: This case involves a G₃P₁ that presented to Labor & Delivery at 28 5/7 weeks gestation with premature rupture of membranes. Her obstetrical history includes one SAB, and one 24 week preterm delivery of an infant that died at 8 days of life.  Her medical history is complicated by positive HIV infection, bipolar depression, multifocal demyelination disorder, and advanced maternal age. Her HIV status was diagnosed during her current pregnancy, and she was placed on a combination antiretroviral regimen. Her last viral load prenatally was undetectable. 

Upon presentation to Labor & Delivery, she stated she had been leaking fluid for 1½ hours. No signs of labor or vaginal bleeding were noted on admission.  Rupture of membranes was confirmed. She was placed on latency antibiotics and given corticosteroids for fetal lung maturation.  Following consultation with Infectious Disease, NICU, MFM and Neurology, it was decided to continue her prenatal antiviral drug regimen.  Repeat CD4 count and viral load labwork was performed confirming undetectable viral load.

Following transfer to our AP unit, she received a psych consult for her depression and anxiety, and an occupational therapy consult for her demyelination syndrome. She was counseled regarding contraceptive care and bottle feeding as the preferred method to reduce transmission. 

At 29 5/7 weeks, she began experiencing cramping, vaginal bleeding and signs of chorioamnionitis.  She was transferred to Labor & Delivery, where the decision was made to proceed with a cesarean section.  Per CDC guidelines, IV AZT was started and allowed to infuse for the recommended 3 hours prior to delivery.  Infant was born with 8/9 Apgars, was bathed in OR, and transferred to NICU on room air. The infant was started on antivirals, with a plan to continue for the first 6 weeks of life.