Quiz 3: HIV during labour and delivery

Choose the one, most correct answer to each question or statement.

1. What is the chance of mother-to-infant transmission of HIV during labour and vaginal delivery if the woman is not receiving antiretroviral prophylaxis?
   • 5%
   • 15%
   • 25%
   • 50%
2. Can HIV infection be diagnosed for the first time during labour?
   • Yes, by using a rapid screening test
   • Only if the labour lasts longer than 12 hours as the test takes many hours to perform
   • Only if the woman has clinical signs of AIDS
   • No
3. During labour, women who are living with HIV should be:
   • Isolated in a single ward and barrier nursed
   • Cared for with other women in the general labour ward
   • Cared for in a clinic only and not admitted to a hospital if complications develop
   • Always be cared for at home where they cannot infect other patients
4. In women who are living with HIV, the membranes should:
   • Be ruptured as soon as possible to speed up the labour
   • Be ruptured when the cervix reaches 4 cm dilatation
   • Only be ruptured when the cervix is 8 cm dilated
   • Not be artificially ruptured unless there is a good clinical indication
5. In women living with HIV:
   • The risk of preterm labour is the same as in HIV-negative women
   • The risk of preterm labour is doubled
   • The risk of preterm labour is reduced
   • Preterm labour is rare
6. The risk of vertical transmission is increased in:
   • Preterm labour
   • Post-term labour
   • Term labour
   • Rapid labours
7. Does HIV infection in a well-nourished mother cause intra-uterine growth restriction?
   • Usually it does
   • Usually it does not
   • Only if the mother is receiving zidovudine (AZT)
   • Only if chorioamnionitis is present
8. The following procedure may reduce the risk of mother-to-infant transmission of HIV, especially if ARV prophylaxis has not been used:
   • Elective Caesarean section
   • A Caesarean section while in labour
   • An episiotomy
   • Vacuum extraction
9. Caesarean section in women living with HIV:
   • Increases the risk of maternal wound sepsis
   • Decreases the risk of maternal pneumonia in the puerperium
   • Increases the risk of bacterial infection in the infant
   • Decreases the risk of hyaline membrane disease in the infant
10. In women living with HIV, an episiotomy should:
    • Be done routinely to shorten the second stage of labour
    • Should never be done because it does not heal
    • Should only be done if there is a good clinical reason as it may increase the risk of vertical transmission to the infant
    • Only be done by a doctor
11. Which women living with HIV are at greatest risk of transmitting the virus to their infant?
    • Women in the latent phase of the infection
    • Women who have clinical signs of advanced HIV disease
    • Women who have short labours
    • Women who have not transmitted HIV to their previous children
12. Vaginal wiping with chlorhexidine during labour in women living with HIV may:
    • Reduce the risk of HIV transmission
    • May reduce the risk of puerperal sepsis and neonatal sepsis
    • Cause inflammation and increase the risk of HIV transmission
    • Reduce the risk of meconium aspiration
13. After delivering the infant of a woman living with HIV:
    • The infant’s mouth should be well suctioned.
    • The infant should not be fed for 12 hours.
    • The infant should be well dried.
    • The infant should not be given to the mother for at least six hours.
14. During labour and delivery mothers on TLD should:
    • Receive a single dose of NVP
    • Continue with daily TLD
    • All ARV drugs should temporarily be stopped and only restarted after delivery
    • Receive 3 hourly AZT
15. What drugs should be given to women at the same time or after delivery if they receive a single dose of nevirapine in labour?
    • AZT and 3TC
    • TLD
    • Nevirapine and AZT
    • Lopinavir and ritonavir
16. The following procedure may reduce the risk of mother-to-infant transmission of HIV during labour and delivery by 50% if an unbooked mother is diagnosed to be living with HIV when admitted in labour:
    • Giving the infant intramuscular vitamin K after delivery
    • Active management of the third stage of labour
    • Speed up labour with an oxytocin infusion
    • Giving the mother a single dose of NVP
17. Which risk factor is associated with an increased risk of HIV transmission during labour even if ARV drugs are used correctly for prophylaxis or treatment?
    • Elective Caesarean section
    • Postterm delivery
    • Male infant
    • A high viral load
18. How can staff reduce the risk of becoming infected with HIV themselves during the management of labour?
    • They should not perform vaginal examinations.
    • They should not rupture the membranes.
    • They should wear gloves, goggles and a plastic apron.
    • They should be immunised against HIV.
19. How can staff reduce the risk of becoming infected themselves with HIV during Caesarean section or episiotomy repair?
    • Needles should always be held with forceps.
    • The patient must be washed with chlorhexidine.
    • Hands should be washed after the procedure is completed.
    • Needles must be hand-held whenever possible.
20. What form of family planning will reduce the risk of spreading HIV to a sexual partner?
    • Tubal ligation
    • Injectables, such as Depo-Provera
    • Male or female condoms
    • Oral contraceptives