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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