Which action reduces the risk of mother-to-child transmission of HIV during childbirth?

AIIMS CRE 2025

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS CRE 2025

Explanation

A scheduled Cesarean section (LSCS) before labor begins and before the membranes rupture is a primary strategy to reduce HIV transmission during birth.
This surgical delivery minimizes the baby's contact with the mother's blood and vaginal fluids, which are the main sources of the virus during a vaginal delivery.
It is particularly recommended for mothers who have a high or unknown viral load (greater than 1,000 copies/mL) near the time of delivery.
The procedure is typically planned for 38 weeks of gestation to avoid the spontaneous onset of labor.

Option A: Stopping antiretroviral therapy (ART) is dangerous as it allows the virus to multiply, increasing the mother's viral load and significantly heightening the risk of transmission to the baby. Continuous ART is essential.
Option C: Avoiding ART altogether leads to an uncontrolled viral load in the mother, which is the single most important factor for increasing the risk of passing HIV to the baby.
Option D: Weaning relates to feeding after birth (postpartum period) and aims to prevent transmission through breast milk. It does not address the risk of transmission that occurs during the process of childbirth itself.

Visual 1: Infographic: A flowchart showing the three main periods of mother-to-child HIV transmission (in utero, intrapartum, postpartum) and the corresponding prevention strategies for each.
Visual 2: Illustration: A diagram comparing a vaginal delivery versus a Cesarean section, highlighting the points of potential exposure to maternal fluids that are bypassed during a planned C-section.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prevention of mother-to-child transmission (MTCT) of HIV during childbirth as background academic context rather than a clinical decision trigger.
Nurses play a critical role in educating HIV-positive mothers about the importance of ART adherence and the planned mode of delivery to ensure they are active participants in their care.
A key nursing responsibility is to administer intravenous Zidovudine (an ART drug) during labor as prescribed, which provides an extra layer of protection for the baby, especially if the mother's viral load is high or unknown.
What if? If the mother's viral load is consistently undetectable (e.g., less than 50 copies/mL) near delivery, a vaginal delivery may be considered as safe as a C-section. In this case, the plan might change from a scheduled LSCS to allowing a trial of labor, as the risk of transmission is very low (less than 1%).

How to Approach the Question

First, identify the core of the question: it asks for an action to reduce HIV transmission during childbirth (the intrapartum period).
Analyze each option based on this specific timeframe.
Options A (Stopping ART) and C (Avoiding ART) are counterintuitive for controlling a virus. A higher viral load means a higher risk. These can be eliminated as incorrect.
Option D (weaning) is related to feeding after birth (postpartum), not the birth process itself. This is a different transmission window.
Option B (LSCS) is a direct intervention during the childbirth period that physically separates the baby from infectious maternal fluids. This makes it the most logical and effective intervention specifically for the intrapartum period.

Concept Tested & Keywords

Concept Tested: Prevention of mother-to-child transmission (MTCT) of HIV during childbirth.
Stem keywords: mother-to-child transmission, HIV, childbirth, reduces risk
Lead-in keywords: Which action
Clinical cues: HIV-positive mother
Negative lead-in flag: false

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