• Guiding the mode of delivery (Vaginal vs Cesarean) in pregnant individuals living with HIV.
• Determining the necessity for intrapartum intravenous Zidovudine (AZT).
• Preventing Mother-to-Child Transmission (PMTCT) of HIV during labor and delivery.

• If viral load is strictly undetectable, avoiding artificial rupture of membranes (AROM), fetal scalp electrodes (FSE), and operative vaginal delivery is no longer absolutely mandated, but still strongly cautioned.
• Avoid Methergine (methylergonovine) for postpartum hemorrhage routine prophylaxis if the patient is on a Protease Inhibitor (e.g., Ritonavir, Darunavir) or Cobicistat. Extreme vasoconstriction and catastrophic ischemia can occur due to CYP3A4 inhibition.

Historically, breastfeeding was an absolute contraindication for HIV-positive mothers in resource-rich settings. Modern DHHS guidelines now explicitly state that if a mother is virologically suppressed (undetectable) and strongly desires to breastfeed, providers should NOT contact Child Protective Services, but instead offer patient-centered, shared decision-making support.

• Required if VL >1,000, 50-999, or unknown.
• Loading Dose: 2 mg/kg IV over 1 hour.
• Maintenance: 1 mg/kg/hour IV continuous infusion.
• Target: Initiate 3 hours prior to scheduled C-section or immediately upon admission in labor.
• Continue until umbilical cord clamping.

The Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 published in 1994 was the revolutionary placebo-controlled trial that proved Zidovudine could prevent maternal-fetal transmission, fundamentally changing the trajectory of the global AIDS pandemic.