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Case Studies. Revised from the The Francois Xavier Bagnoud Center New York / New Jersey AIDS Education & Training Center and The Center for Continuing and Outreach Education at the University of Medicine and Dentistry of New Jersey.

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case studies

Case Studies

Revised from the The Francois Xavier Bagnoud Center New York / New Jersey AIDS Education & Training Center and The Center for Continuing and Outreach Education at the University of Medicine and Dentistry of New Jersey.

HIV Infection and Pregnancy: Prevention and Care, Faculty Training Program.

case study 1 hiv counseling and testing during labor
Case Study 1: HIV counseling and testing during labor
  • You Begin to explain to Ms. Q that her prenatal record does not indicate that she has had an HIV test during this pregnancy and that it is recommended for every pregnant woman. Ms. Q becomes angry and says “What kind of woman do you think I am?”
case study 3 barrier s to rapid testing
Case Study 3: Barrier’s to Rapid Testing
  • Ms. G has just been admitted to L&D. No HIV test results are on her chart. Her husband and her mother are with her. She is uncomfortable. The family are recent immigrants and speak little English.
  • You need to take an admission history including asking about HIV testing in labor.
case study 4 patient declined hiv test in pregnancy needs counseling for rapid testing on l d
Case Study 4:Patient declined HIV test in pregnancy, needs counseling for rapid testing on L&D

John and Sally, a couple in their early 20s, arrive on labor and delivery, Sally is in early labor with her first baby. They have been married for about 18 months and have been together for 3 years.

She does not have a documented prenatal HIV test. Her nurse asks her about HIV testing during pregnancy, Sally replies that she declined testing because she doesn’t think she needs an HIV test, John is the only man she has been with.

case study 5 preliminary positive rapid test on l d not in labor
Case Study 5: Preliminary Positive Rapid Test on L&D, not in labor

Susan L was seen on L&D for a UTI at 30 weeks gestation, her prenatal records were not available, a rapid HIV test was done on arrival after counseling and consent was obtained by her nurse. The nurse found the test to be positive after 20 minutes.

Counseling about a preliminary positive HIV test

  • Susan: Cannot believe the test. She feels it must be wrong. No risk factors. She has been faithful to her husband.
case study 6 a negative test during labor
Case Study 6:A negative test during labor
  • Ms. M was not offered an HIV test during her prenatal care. She consented to have a rapid test during labor. The result of the test is negative. She asks the nurse if she can be certain that she doesn’t have HIV.
  • What are the key issues?
case study 7 positive rapid test in labor an hiv exposed infant
Case Study 7: Positive Rapid Test in Labor, an HIV-exposed infant

One hour after arrival to L&D, Angela G’s Rapid HIV test comes back positive. She tested negative early in her pregnancy but the test was repeated on admission to L&D because she reported that her husband was “back to using IV drugs”. She is in active labor and needs an epideral.

  • What are the important steps to take in labor, and postpartum to best treat this mother and infant and prevent transmission?
  • What follow-up care is needed for Angela and her baby?
case study 8 known hiv in labor with rom
Case Study 8: Known HIV +, In labor with ROM

Joan, G8P3, HIV+ for 3 years, is admitted with ruptured membranes and labor. No prenatal care. Lost 2 children to HIV. Urine + for cocaine, GB strep+ (urine, cervix), other STDs negative. CD4+ 845.

  • What are the recommendations for this mother and infant?
  • What clinical and psychosocial issues does this case present?
  • What should follow-up care include?