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Unit 4 care of the hiv infected mother

  1. 1. Care of the HIV Infected mother during pregnancy, labour, Delivery and in the post-partum period and use of ART
  2. 2. Session Objective and content <ul><li>Objective: </li></ul><ul><ul><ul><li>At the end of the session the participant should be able Describe the care of the HIV infected mother; pre-pregnancy; during pregnancy; labour; delivery and post partum and use of ART </li></ul></ul></ul><ul><li>Content </li></ul><ul><ul><ul><li>Pre pregnancy care -- discordant couples, </li></ul></ul></ul><ul><ul><ul><li>Antenatal care -- nutrition, psychosocial support, management and prophylaxis of opportunistic infections (OI), </li></ul></ul></ul><ul><ul><ul><li>Intrapartum care – delivery plan, modified obstetric practices, universal precautions, and care of newborn </li></ul></ul></ul><ul><ul><ul><li>Postpartum care – postpartum follow up, contraception, Referral for care of mother and baby </li></ul></ul></ul>
  3. 3. MTCT <ul><li>MTCT of HIV occurs during </li></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Labour and delivery </li></ul></ul><ul><ul><li>Breastfeeding </li></ul></ul><ul><ul><li>Overall, the transmission rate is 40% without interventions. </li></ul></ul>
  4. 4. PMTCT Targets <ul><li>Primary prevention </li></ul><ul><li>Prevention of transmission by modifying transmission risk factors </li></ul><ul><li>Prevention of unintended pregnancy among positives </li></ul><ul><li>Linkages to care </li></ul>
  5. 5. Pre pregnancy care <ul><li>Promote abstinence or being faithful to one uninfected partner. </li></ul><ul><li>Promote correct use of condoms each time. </li></ul><ul><li>Prevent or identify and treat STIs promptly. </li></ul><ul><li>Counsel and test women and their partners for HIV. </li></ul><ul><li>Keep HIV-negative adults, negative. </li></ul>
  6. 6. Antenatal Care <ul><li>Includes early identification and tx for factors that increase MTCT risk </li></ul><ul><li>STIs </li></ul><ul><li>TB – more than 60% of persons infected with TB are also HIV-infected </li></ul><ul><li>Malaria </li></ul>
  7. 7. Antenatal antiretrovirals <ul><li>ARV therapy </li></ul><ul><ul><li>Long-term use of antiretroviral drugs to manage maternal HIV/AIDS and prevent PMTCT. </li></ul></ul><ul><li>ARV prophylaxis </li></ul><ul><ul><li>Short-term use of antiretroviral drugs to reduce HIV transmission from mother to infant. </li></ul></ul><ul><ul><ul><li>Prophylaxis with nevirapine </li></ul></ul></ul><ul><ul><ul><li>Prophylaxis with AZT and nevirapine </li></ul></ul></ul><ul><ul><ul><li>Prophylaxis with HAART </li></ul></ul></ul>
  8. 8. Intrapartum Care <ul><li>Provide ARVs during labour. </li></ul><ul><li>Use Universal Precautions. </li></ul><ul><li>Minimise vaginal examinations. </li></ul><ul><li>Avoid prolonged labour. </li></ul><ul><li>Avoid artificial rupture of membranes. </li></ul><ul><li>Avoid routine episiotomy. </li></ul><ul><li>Minimise the risk of postnatal haemorrhage. </li></ul><ul><li>Use safe transfusion practices. </li></ul>
  9. 9. Postpartum Care Education <ul><li>Information mothers need </li></ul><ul><li>Proper hygiene </li></ul><ul><li>Care for infant’s umbilicus </li></ul><ul><li>Recognising signs/symptoms of infection </li></ul><ul><li>Accessing help in the event of haemorrhage </li></ul><ul><li>Optimal nutritional requirements including rehydration </li></ul><ul><li>Dual protection for family planning and infection prevention </li></ul><ul><li>Postpartum follow-up for mother, infant, and family </li></ul>
  10. 10. Post pregnancy Care <ul><li>Follow-up care for infant includes </li></ul><ul><li>Monitoring infant growth and development </li></ul><ul><li>Immunisations </li></ul><ul><li>HIV testing </li></ul><ul><li>Follow up care of the mother includes </li></ul><ul><li>Monitoring of the mother </li></ul><ul><li>Family planning </li></ul><ul><li>Individual and couples counselling </li></ul><ul><li>Continued risk assessment </li></ul><ul><li>Early diagnosis and treatment of STIs </li></ul><ul><li>Information and skills to practise safer sex </li></ul>