Vertical transmission of HIV is more commonly occur during?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

The intranatal period, which encompasses labor and delivery, is the time when vertical transmission of HIV is most likely to occur.
This is because the baby is exposed to the mother's blood and genital secretions in the birth canal.
Studies indicate that without antiretroviral therapy (ART), approximately 50-65% of all mother-to-child transmissions happen during this period.
Factors like a high maternal viral load and prolonged rupture of membranes significantly increase this risk.

Option A: While transmission can occur during the antenatal period (in utero) via the placenta, it accounts for a smaller proportion of cases (around 20-30%) compared to the intranatal period.
Option C: Postnatal transmission occurs primarily through breastfeeding. While a significant risk, especially in settings where breastfeeding is common and maternal ART is not used, it is generally less frequent (12-20%) than intranatal transmission.
Option D: The risk of transmission is not equal across all stages. The evidence clearly shows a significantly higher risk during the intranatal period compared to the antenatal and postnatal periods.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Timing and risk factors for vertical transmission of Human Immunodeficiency Virus (HIV) as background academic context rather than a clinical decision trigger.
The cornerstone of preventing vertical HIV transmission is the use of antiretroviral therapy (ART) in the mother, which can reduce the transmission rate to less than 1%.
Nurses play a critical role in counseling pregnant women about HIV testing, ensuring adherence to ART, managing labor to minimize risk, and providing care and prophylaxis to the newborn.
What if? If the mother is on effective ART and has an undetectable viral load (less than 50 copies/mL), the risk of transmission during a vaginal delivery is extremely low (less than 1%), making a scheduled cesarean section for HIV prevention unnecessary.

How to Approach the Question

First, identify the core concept of the question, which is 'vertical transmission of HIV'.
Recognize the keyword 'more commonly', which asks for the period with the highest frequency of transmission.
Recall the three main periods of mother-to-child transmission: antenatal (pregnancy), intranatal (birth), and postnatal (breastfeeding).
Compare the relative risk associated with each period. Remember that exposure to maternal blood and fluids is greatest during labor and delivery.
Conclude that the intranatal period presents the highest risk, making it the correct answer.

Concept Tested & Keywords

Concept Tested: Timing and risk factors for vertical transmission of Human Immunodeficiency Virus (HIV).
Stem keywords: Vertical transmission, HIV, more commonly
Lead-in keywords: more commonly

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 2096-2098

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