The document discusses care for pregnant women with HIV/AIDS, including prevention of parent-to-child transmission (PPTCT). Key points include: HIV can be transmitted from mother to child during pregnancy, delivery, or breastfeeding; antiretroviral therapy and safer delivery practices can reduce transmission risk; and PPTCT programs aim to prevent transmission through counseling, testing, treatment and supporting safer infant feeding options.
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Â
Hiv aids (1)
1. PREGNANT WOMEN WITH HIV/AIDS:
CARE DURING ANTENATAL,
INTRANATAL & POSTNATAL PERIOD.
PPTCT-VTCT.
2. INTRODUCTION:
īĸ Acquired Immunodeficiency Syndrome (AIDS) is caused
by the Human Immunodeficiency Virus (HIV) of strains
HIV 1 & HIV 2.
īĸ The first HIV virus was discovered in 1983 by Barre -
Sinoussi & colleagues in Paris.
īĸ Around 6 lakh children become infected worldwide each
year.
īĸ Almost all is because of the infection derived from the
mother.
īĸ In India, nearly 4 million people are infected with HIV.
More than 50% of them are women & children.
3. MODE OF TRANSMISSION:
īĸ Sexual intercourse
īĸ Transfusion of contaminated blood or blood
products
īĸ Use of contaminated needles or needle stick
injuries
īĸ Breast feeding
īĸ Perinatal transmission:
a. antenatal- through placental transfer.
b. Intranatal- by contaminated secretions
c. Postnatal- through breast feeding
4. PATHOLOGY:
īĸThe target for HIV is CD 4 receptor molecule.
īĸThese molecules are found in certain cells within
the immune system like T lymphocytes,
monocytes, macrophages, etc.
īĸHIV infection results in a progressive decline in
the number & function of these cells.
īĸThis results in profound immunodeficiency state
with clinical manifestations in nearly all systems
of the body.
īĸCD 4 counts greater than 800 cells/mm3 are
considered normal.
5. īĸIn early stage of disease: CD 4 >500 cells/mm3
īĸIn intermediate stage: CD 4 is between 200-
500 cells/mm3 .
īĸIn advanced stage: CD 4 < 200 cells/mm3 .
(now it is called as AIDS)
īĸThe duration of time from initial infection to
AIDS can vary from 3 yrs to several decades.
6. CLINICAL PRESENTATION:
īĸFollowing exposure to HIV, a patient develops
antibodies against HIV in about 8-12 wks.
īĸLater starts the acute infection syndrome
characterized by flu like symptoms, skin rash,
lymphadenopathy diarrhoea, mouth ulcer,
gingivitis, etc.
īĸInitial stage patient remains asymptomatic. As
CD 4 level falls symptoms occur in nearly all the
body systems.
īĸInfection in genital tract: vag candidiasis, PID,
Neoplasms, etc. develops.
7. DIAGNOSIS:
īĸThe diagnosis of HIV infection requires
identification of antibodies to HIV & decreased
CD 4 count.
īĸELISA test (Enzyme Linked Immuno Sorbent
Assay): detects antibodies against HIV-1 & 2.
Antibodies are detected after 4-12 weeks after
infection. (window period). It is easy, cheap &
less time consuming.
īĸWestern blot test: highly specific but time
consuming, expensive & complicated.
8. TREATMENT:
A. Antenatal period:
īĸ Prevention: use of condoms, avoid needle stick
injury, infusion of screened blood, maintenance of
proper techniques of disposal of wastes.
īĸ Counselling & support
īĸ Antiretroviral therapy: Zidovudine is the drug of
choice. Several combination therapies can also be
used which includes drug like Delvirdine, Ritonavir,
etc. combination therapy is called as HAART
(Highly Active Antiretroviral Therapy).
īĸ These combinations increase the CD 4 count &
reduces the virus load, as monotherapy causes
drug resistance.
9. īĸ ZDV therapy is started anytime between 14 to 34 wks &
then continued throughout pregnancy, labour &
puerperium.
īĸ ZDV 100 mg given 5 times daily PO can reduce perinatal
transmission from 25 % to 7%
B. Intrapartum care:
īĸ ZDV is given IV inf. at onset of labour in vaginal
delivery or 4 hrs before CS.
īĸ Loading dose: 2 mg/kg/hr
īĸ Maintenance dose: 1 mg/kg/hr until cord is clamped.
īĸ Elective CS-reduces risk of vertical transmission by
50%.
īĸ Cord should be clamped as early as possible & baby
should be bathed immediately.
10. īĸ Amniotomy & attachment of scalp electrode should be
avoided.
īĸ During delivery caps, masks, gown, protective eye wear
(goggles) & double gloves should be worn.
īĸ Washing off any blood or secretions contamination off
the skin immediately
īĸ Midwives should be very careful to avoid needle prick.
īĸ Post exposure prophylaxis with ZDV 200mg thrice daily
for 4 wks-in case exposure to infected blood occurs.
īĸ Thorough theatre disinfection after operation.
11. C. Post partum care:
īĸ Breast feeding: should be avoided. But
when alternative forms of infant nutrition
are not safe, the minor risk associated
with breast feeding may be accepted.
īĸ ZDV syrup: 2 mg/kg, is given to neonate
4 times daily for first 6 wks of life.
īĸ Contraception: barrier methods like use
of condoms is encouraged
12. CONCLUSION:
īĸHIV/AIDS during pregnancy is one of the
major health problem world wide.
īĸPerinatal transmission:
a. antenatal- through placental transfer.
b. Intranatal- by contaminated secretions
c. Postnatal- through breast feeding
īĸTreatment mainly concerns with the use of
antiretroviral therapy, safer sex practices,
infusion of screened blood, avoidance of
contact with infected articles.
13. PPTCT:
īĸ Its full form is PREVENTION OF PARENT TO
CHILD TRANSMISSION OF HIV.
īĸ The predominant mode of transmission of HIV in
children is vertical i.e., it is acquired from an HIV
infected mother.
īĸ Parent-To Child Transmission (PPTCT) of HIV can
occur
īĸ 1. during pregnancy
īĸ 2. at the time of delivery
īĸ 3. through breastfeeding
14. PPTCT INTERVENTION PACKAGE:
īĸ The package consists of
īĸ 1. Antenatal Care
īĸ 2.Group Education & Pre Test Counselling
īĸ 3.Rapid HIV Testing
īĸ 4.Post Test Counselling
īĸ 5.CD 4 Cell Count & linkage to ART Centre if necessary
īĸ 6.Institutional Delivery
īĸ 7. Administration of Nevirapine to the woman during labour
īĸ 8. Administration to the baby of Suspension Nevirapine
between 24-72 hours
īĸ 9.Counselling of mother for Infant Feeding Options
īĸ 10.Care & Support
īĸ 11. Follow Up
15. ELEMENTS OF PPTCT PROGRAMME:
īĸ Promotion and provision of free, subsidized or
commercially marketed condoms, provide diagnosis for
treatment of STDs and behaviour change
communication efforts to reduce behaviour that place
individuals at risk, and information about risks of PTCT
during pregnancy, delivery, breastfeeding &
encouragement to see VCT counselor(voluntary
counselling & testing) or health provider for information
on how to prevent HIV/AIDS among infants & young
children.
īĸ Prevention of unintended pregnancies in HIV positive
women through reproductive health services, which
include family planning.
16. īĸPrevention of transmission from an
HIV positive women to her infant
through anti-retroviral (ARV)
prophylaxis and safer delivery
practices
īĸCare and support services to HIV-
infected women who are enrolled with
the programme and to their children
and families, including counseling on
infant feeding.