Dr S
|MANAGEMENT OF HIV & PREGNANCY |
|PERINATAL CARE PLAN |
(A full version of the regional guidelines may be found at liv.ac.uk/hiv)
| |
|To be completed by HIV Physician by 28 weeks’ gestation with copies to: |
|Obstetric Notes |GP (with consent) |
|GUM/ID Case Notes |Patient hand held notes (with consent) |
|Midwife & Labour Ward |Neonatologist |
|Paediatrician |Ward 3Y, RLUH |
|Network Electronic Storage (rlb-tr.HIV-Pregnancy-Network@) |
|PATIENT ADDRESSOGRAPHS |
|OBSTETRICS |GUM |HOSPITAL |
|Name: | |Name: | |Name: | |
|DOB: | |DOB: | |DOB: | |
|Hosp No. | |Hosp No. | |Hosp No. | |
|EDD | |Planned mode of delivery | |
|Obstetrician | | | |
|HIV Physician | | | |
|Neonatologist | | | |
|Paediatrician | | | |
|Screening Midwife | | | |
|Paediatric Nurse | | | |
|GP | | |
|CONFIDENTIALITY |
|GP |NOT AWARE / AWARE |FAMILY |NOT AWARE / AWARE |
|NAME OF BIRTH PARTNER | |NOT AWARE / AWARE |
|CONSENT TO INFORM HEALTH VISITOR |YES / NO |
|DISCUSSIONS WITH MOTHER |
|ADVICE RE: PREMATURE RUPTURE OF MEMBRANES |YES / NO |
|ADVICE NOT TO BREAST FEED |YES / NO |
|ADVICE RE: POST-NATAL CONTRACEPTION |YES / NO |
|ANTENATAL CARE PLAN – HIV MANAGEMENT |
|HARS/APR/NHSPC Submission |YES / NO |Date | |
If new HIV diagnosis – plan partner testing, existing children and counselling for safe sex.
|Dates of GUM screen: |Early ( ................
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