This lecture describes the approach to screening, diagnosis and management of HIV and TB infection among pregnant patients. Prevention of Mother to Child Transmission of HIV infection mainly based on the Philippine Obstetrical and Gynecological Society Clinical Practice Recommendations.
This document discusses the pharmacologic management of deep vein thrombosis (DVT) in pregnancy and related nursing implications. It notes that DVT is a leading cause of maternal death in the US, with an incidence of 1 in 500-2000 deliveries. Risk factors include physiological changes of pregnancy as well as acquired and inherited factors. Treatment involves therapeutic anticoagulation with low molecular weight heparin or unfractionated heparin, which are safe in pregnancy. Nursing implications include monitoring for signs of bleeding or allergic reaction and educating patients on prevention measures.
This document discusses pulmonary tuberculosis in pregnant women. It notes that 30% of global TB cases are in India, and 5% of pregnant women have active TB disease. It outlines symptoms of TB in pregnancy like fatigue, fever, and cough. It discusses evaluating and treating TB in pregnancy, including using directly observed therapy. Side effects on the fetus are considered minimal. Vaginal delivery is generally safe while avoiding certain drugs. Breastfeeding is also generally recommended while taking precautions if the mother has active TB.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
The document discusses intrauterine fetal demise (IUFD), defined as the death of a fetus weighing over 500g or over 24 weeks gestation before the onset of labor. It notes that the cause is unknown in 25-60% of cases. Identifiable causes include maternal conditions like diabetes or hypertension, fetal conditions like birth defects or infections, and placental conditions like abruption or insufficiency. Evaluation of an IUFD involves examining the mother's medical history and current pregnancy, evaluating the stillborn infant, investigating the placenta, and certain laboratory tests. Management depends on factors like gestation, number of fetuses, and the parents' wishes regarding expectant or active management such as labor induction. Complications can
This document discusses maternal near miss (MNM), which refers to women who nearly die but survive severe complications during pregnancy or childbirth. The World Health Organization recommends criteria for identifying MNM cases, including disease-specific conditions, management-based interventions, and organ dysfunction. Studying MNM provides advantages over solely examining maternal mortality, as MNM cases are more common and can reveal deficiencies in healthcare. Identifying and reviewing MNM cases can help reduce maternal mortality by informing actions to address gaps and improve quality of care. The document reviews several studies of MNM cases in Egypt which found the most common morbidities were related to preeclampsia, hemorrhage, and organ dysfunctions like coagulation issues. MNM
This summary reviews several studies on how asthma is affected during pregnancy. The studies show rates of asthma worsening from 14-41% of patients, unchanged in 26-43%, and
This document discusses the pharmacologic management of deep vein thrombosis (DVT) in pregnancy and related nursing implications. It notes that DVT is a leading cause of maternal death in the US, with an incidence of 1 in 500-2000 deliveries. Risk factors include physiological changes of pregnancy as well as acquired and inherited factors. Treatment involves therapeutic anticoagulation with low molecular weight heparin or unfractionated heparin, which are safe in pregnancy. Nursing implications include monitoring for signs of bleeding or allergic reaction and educating patients on prevention measures.
This document discusses pulmonary tuberculosis in pregnant women. It notes that 30% of global TB cases are in India, and 5% of pregnant women have active TB disease. It outlines symptoms of TB in pregnancy like fatigue, fever, and cough. It discusses evaluating and treating TB in pregnancy, including using directly observed therapy. Side effects on the fetus are considered minimal. Vaginal delivery is generally safe while avoiding certain drugs. Breastfeeding is also generally recommended while taking precautions if the mother has active TB.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
The document discusses intrauterine fetal demise (IUFD), defined as the death of a fetus weighing over 500g or over 24 weeks gestation before the onset of labor. It notes that the cause is unknown in 25-60% of cases. Identifiable causes include maternal conditions like diabetes or hypertension, fetal conditions like birth defects or infections, and placental conditions like abruption or insufficiency. Evaluation of an IUFD involves examining the mother's medical history and current pregnancy, evaluating the stillborn infant, investigating the placenta, and certain laboratory tests. Management depends on factors like gestation, number of fetuses, and the parents' wishes regarding expectant or active management such as labor induction. Complications can
This document discusses maternal near miss (MNM), which refers to women who nearly die but survive severe complications during pregnancy or childbirth. The World Health Organization recommends criteria for identifying MNM cases, including disease-specific conditions, management-based interventions, and organ dysfunction. Studying MNM provides advantages over solely examining maternal mortality, as MNM cases are more common and can reveal deficiencies in healthcare. Identifying and reviewing MNM cases can help reduce maternal mortality by informing actions to address gaps and improve quality of care. The document reviews several studies of MNM cases in Egypt which found the most common morbidities were related to preeclampsia, hemorrhage, and organ dysfunctions like coagulation issues. MNM
This summary reviews several studies on how asthma is affected during pregnancy. The studies show rates of asthma worsening from 14-41% of patients, unchanged in 26-43%, and
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis bacteria and is spread through airborne droplets. It commonly affects the lungs but can infect other organs. Pregnancy increases risks for both mother and fetus. Diagnosis involves tests like chest x-rays and sputum samples. Treatment includes a combination of antibiotics taken daily for 9 months. Nursing care focuses on monitoring for symptoms, ensuring treatment adherence, health promotion, and preventing transmission to the newborn.
- Tumor markers are glycoproteins detected by monoclonal antibodies that are produced by tumors or the body's response to cancer.
- Cancer antigen 125 (CA-125) is an important tumor marker used for ovarian cancer screening, diagnosis, treatment monitoring and recurrence detection, though it can be elevated in some non-cancerous conditions.
- For screening, CA-125 levels above 35 U/mL in postmenopausal women or 200 U/mL in premenopausal women should be further evaluated. Monitoring CA-125 after treatment can indicate response or recurrence of ovarian cancer.
This document summarizes guidelines on the use of antenatal corticosteroids. It states that a single course of antenatal corticosteroids between 24-34 weeks of gestation significantly reduces neonatal death, respiratory distress syndrome, and intraventricular hemorrhage, with no known benefits or harms for the mother. It provides guidance on appropriate patients, timing, dosage, and considerations for particular clinical contexts. Repeating courses weekly is not recommended due to potential effects on growth, though a second course may be considered in limited circumstances.
The document discusses pulmonary tuberculosis, which is caused by Mycobacterium tuberculosis bacteria and spreads through airborne droplets. Symptoms include cough, fever, weight loss, and fatigue. Diagnosis involves tests of sputum and chest x-rays. Tuberculosis can affect the lungs and other organs. While pregnancy increases risks for both mother and baby, treatment aims to cure the mother's infection to prevent spread. Management involves multidrug therapy, monitoring for side effects, and ensuring treatment adherence and compliance.
This document discusses uterine rupture, a serious obstetric complication where the wall of the pregnant uterus tears. It has a high risk of maternal and perinatal mortality. Uterine rupture can occur during labor, delivery, or rarely during pregnancy. It has an incidence of 0.05% for all pregnancies, rising to 0.8% for those with a previous cesarean section. Causes include a weak scar from prior uterine surgery, obstructed labor, or uterine overstimulation from medications. Symptoms include abdominal pain, vaginal bleeding, and non-reassuring fetal heart rate. Diagnosis is usually made during emergency surgery, with ultrasound sometimes identifying signs of rupture. Treatment requires intensive resuscitation
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
This document discusses fetal distress, also known as nonreassuring fetal status. It can be defined as hypoxia that may result in permanent brain damage or death for the fetus if the cause is not addressed immediately. Some potential causes of fetal distress include maternal hypoxia, placental issues, obstetric complications, and prolonged compression of the fetal head. Effects on the fetus can include growth issues, decreased movement, low amniotic fluid, stillbirth, and effects on the infant like brain injury and meconium aspiration. Assessment methods discussed include monitoring fetal movement, ultrasounds, amniocentesis, biophysical profile testing, and electronic fetal monitoring during labor.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
HIV & TB are serious pandemics affecting millions worldwide. Both can severely weaken the immune system and lead to opportunistic infections. When contracted during pregnancy, they pose risks like preterm birth, low birthweight, growth restriction, and mother-to-child transmission. Treatment involves comprehensive care and antiretroviral therapy to suppress the virus and prevent transmission. Close monitoring of the mother's viral load and CD4 count along with delivery planning and neonatal prophylaxis are important to reduce transmission risk.
This document provides an overview of diabetes mellitus in pregnancy. It defines diabetes in pregnancy and gestational diabetes, and discusses their incidence rates. It describes the screening, diagnosis, and management of diabetes in pregnancy. The document outlines the maternal and fetal effects of diabetes during pregnancy and notes increased risks of complications. It emphasizes the importance of glucose monitoring and medical nutrition therapy in managing diabetes in pregnancy.
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
HIV infects and damages cells that help the body fight infection and disease. It can be transmitted from mother to child during pregnancy, childbirth, or breastfeeding. To prevent mother-to-child transmission, pregnant women should receive counseling and voluntary testing for HIV. If infected, antiretroviral treatment is recommended during pregnancy and delivery, and avoidance of breastfeeding if safe alternatives are available. Planned c-section or antiretroviral prophylaxis can further reduce the risk of transmission.
Cancer diagnosed during pregnancy most commonly includes breast cancer, lymphoma, and leukemia. Chemotherapy can be used during the second and third trimesters with acceptable risks of fetal complications including low birth weight and prematurity. The first trimester poses the highest risk of teratogenesis from chemotherapy. Surgery is the primary treatment for breast cancer during pregnancy, while chemotherapy and hormone therapy are also options depending on the trimester. Targeted therapies like trastuzumab carry risks of complications in later trimesters and are generally avoided during pregnancy.
This document discusses evaluating and managing bad obstetric history (BOH). BOH refers to previous disappointments in childbearing like miscarriages, stillbirths, preterm births, or other complications. A detailed history and medical record review aims to identify recurrent or non-recurrent causes. Common causes include pre-eclampsia, inherited or acquired thrombophilia, parental genetic disorders, anatomical factors, endocrine issues, and infections. Investigation may include screening tests for these conditions. Management focuses on modifying identified risks in the current pregnancy through treatments like low-dose aspirin for pre-eclampsia risk and close monitoring throughout pregnancy. The goal is to learn from past pregnancies to optimize outcomes in future pregnancies.
Premature rupture of membranes (PROM) refers to rupture of the amniotic sac before the onset of labor. It occurs in 8% of pregnancies and is diagnosed through examination finding fluid in the vaginal vault or pooling in the fornix. Risk factors include infection, cervical issues, and smoking. Management depends on gestational age and includes induction of labor, expectant management up to 24 hours, and antibiotics to prevent complications like chorioamnionitis which occurs when bacteria infect the amniotic sac and can cause maternal fever and sepsis.
The document discusses prevention of parent-to-child transmission (PPTCT) of HIV. It outlines NACO's four-pronged strategy for PPTCT, which includes primary prevention of HIV among women, preventing unintended pregnancies in HIV+ women, preventing transmission from mother to child, and treatment/care for women and children living with HIV. It then discusses factors influencing transmission risk and interventions to reduce risk during pregnancy, delivery, and infancy including antiretroviral prophylaxis and therapy.
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
Tuberculosis in pregnancy can be safely diagnosed and treated. While historically tuberculosis was thought to be harmful during pregnancy, modern treatments with drug combinations like rifampicin, isoniazid and ethambutol have shown no increased risk of malformations or damage when used during pregnancy. Early diagnosis and treatment leads to outcomes similar to non-pregnant women, while late diagnosis increases morbidity. Breastfeeding can also be done safely while the mother receives standard tuberculosis treatment. Screening for HIV is also recommended for pregnant women diagnosed with active tuberculosis.
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis bacteria and is spread through airborne droplets. It commonly affects the lungs but can infect other organs. Pregnancy increases risks for both mother and fetus. Diagnosis involves tests like chest x-rays and sputum samples. Treatment includes a combination of antibiotics taken daily for 9 months. Nursing care focuses on monitoring for symptoms, ensuring treatment adherence, health promotion, and preventing transmission to the newborn.
- Tumor markers are glycoproteins detected by monoclonal antibodies that are produced by tumors or the body's response to cancer.
- Cancer antigen 125 (CA-125) is an important tumor marker used for ovarian cancer screening, diagnosis, treatment monitoring and recurrence detection, though it can be elevated in some non-cancerous conditions.
- For screening, CA-125 levels above 35 U/mL in postmenopausal women or 200 U/mL in premenopausal women should be further evaluated. Monitoring CA-125 after treatment can indicate response or recurrence of ovarian cancer.
This document summarizes guidelines on the use of antenatal corticosteroids. It states that a single course of antenatal corticosteroids between 24-34 weeks of gestation significantly reduces neonatal death, respiratory distress syndrome, and intraventricular hemorrhage, with no known benefits or harms for the mother. It provides guidance on appropriate patients, timing, dosage, and considerations for particular clinical contexts. Repeating courses weekly is not recommended due to potential effects on growth, though a second course may be considered in limited circumstances.
The document discusses pulmonary tuberculosis, which is caused by Mycobacterium tuberculosis bacteria and spreads through airborne droplets. Symptoms include cough, fever, weight loss, and fatigue. Diagnosis involves tests of sputum and chest x-rays. Tuberculosis can affect the lungs and other organs. While pregnancy increases risks for both mother and baby, treatment aims to cure the mother's infection to prevent spread. Management involves multidrug therapy, monitoring for side effects, and ensuring treatment adherence and compliance.
This document discusses uterine rupture, a serious obstetric complication where the wall of the pregnant uterus tears. It has a high risk of maternal and perinatal mortality. Uterine rupture can occur during labor, delivery, or rarely during pregnancy. It has an incidence of 0.05% for all pregnancies, rising to 0.8% for those with a previous cesarean section. Causes include a weak scar from prior uterine surgery, obstructed labor, or uterine overstimulation from medications. Symptoms include abdominal pain, vaginal bleeding, and non-reassuring fetal heart rate. Diagnosis is usually made during emergency surgery, with ultrasound sometimes identifying signs of rupture. Treatment requires intensive resuscitation
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
This document discusses fetal distress, also known as nonreassuring fetal status. It can be defined as hypoxia that may result in permanent brain damage or death for the fetus if the cause is not addressed immediately. Some potential causes of fetal distress include maternal hypoxia, placental issues, obstetric complications, and prolonged compression of the fetal head. Effects on the fetus can include growth issues, decreased movement, low amniotic fluid, stillbirth, and effects on the infant like brain injury and meconium aspiration. Assessment methods discussed include monitoring fetal movement, ultrasounds, amniocentesis, biophysical profile testing, and electronic fetal monitoring during labor.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
HIV & TB are serious pandemics affecting millions worldwide. Both can severely weaken the immune system and lead to opportunistic infections. When contracted during pregnancy, they pose risks like preterm birth, low birthweight, growth restriction, and mother-to-child transmission. Treatment involves comprehensive care and antiretroviral therapy to suppress the virus and prevent transmission. Close monitoring of the mother's viral load and CD4 count along with delivery planning and neonatal prophylaxis are important to reduce transmission risk.
This document provides an overview of diabetes mellitus in pregnancy. It defines diabetes in pregnancy and gestational diabetes, and discusses their incidence rates. It describes the screening, diagnosis, and management of diabetes in pregnancy. The document outlines the maternal and fetal effects of diabetes during pregnancy and notes increased risks of complications. It emphasizes the importance of glucose monitoring and medical nutrition therapy in managing diabetes in pregnancy.
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
HIV infects and damages cells that help the body fight infection and disease. It can be transmitted from mother to child during pregnancy, childbirth, or breastfeeding. To prevent mother-to-child transmission, pregnant women should receive counseling and voluntary testing for HIV. If infected, antiretroviral treatment is recommended during pregnancy and delivery, and avoidance of breastfeeding if safe alternatives are available. Planned c-section or antiretroviral prophylaxis can further reduce the risk of transmission.
Cancer diagnosed during pregnancy most commonly includes breast cancer, lymphoma, and leukemia. Chemotherapy can be used during the second and third trimesters with acceptable risks of fetal complications including low birth weight and prematurity. The first trimester poses the highest risk of teratogenesis from chemotherapy. Surgery is the primary treatment for breast cancer during pregnancy, while chemotherapy and hormone therapy are also options depending on the trimester. Targeted therapies like trastuzumab carry risks of complications in later trimesters and are generally avoided during pregnancy.
This document discusses evaluating and managing bad obstetric history (BOH). BOH refers to previous disappointments in childbearing like miscarriages, stillbirths, preterm births, or other complications. A detailed history and medical record review aims to identify recurrent or non-recurrent causes. Common causes include pre-eclampsia, inherited or acquired thrombophilia, parental genetic disorders, anatomical factors, endocrine issues, and infections. Investigation may include screening tests for these conditions. Management focuses on modifying identified risks in the current pregnancy through treatments like low-dose aspirin for pre-eclampsia risk and close monitoring throughout pregnancy. The goal is to learn from past pregnancies to optimize outcomes in future pregnancies.
Premature rupture of membranes (PROM) refers to rupture of the amniotic sac before the onset of labor. It occurs in 8% of pregnancies and is diagnosed through examination finding fluid in the vaginal vault or pooling in the fornix. Risk factors include infection, cervical issues, and smoking. Management depends on gestational age and includes induction of labor, expectant management up to 24 hours, and antibiotics to prevent complications like chorioamnionitis which occurs when bacteria infect the amniotic sac and can cause maternal fever and sepsis.
The document discusses prevention of parent-to-child transmission (PPTCT) of HIV. It outlines NACO's four-pronged strategy for PPTCT, which includes primary prevention of HIV among women, preventing unintended pregnancies in HIV+ women, preventing transmission from mother to child, and treatment/care for women and children living with HIV. It then discusses factors influencing transmission risk and interventions to reduce risk during pregnancy, delivery, and infancy including antiretroviral prophylaxis and therapy.
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
Tuberculosis in pregnancy can be safely diagnosed and treated. While historically tuberculosis was thought to be harmful during pregnancy, modern treatments with drug combinations like rifampicin, isoniazid and ethambutol have shown no increased risk of malformations or damage when used during pregnancy. Early diagnosis and treatment leads to outcomes similar to non-pregnant women, while late diagnosis increases morbidity. Breastfeeding can also be done safely while the mother receives standard tuberculosis treatment. Screening for HIV is also recommended for pregnant women diagnosed with active tuberculosis.
The document discusses the need for collaborative programs between HIV and tuberculosis (TB) programs. It notes that HIV is the strongest risk factor for TB and TB is a leading cause of death for people living with HIV. It recommends establishing coordinating bodies between HIV and TB programs to conduct joint planning, monitoring and evaluation. Key collaborative activities include intensified TB case finding, TB preventive therapy, and TB infection control for HIV programs and HIV testing, prevention, care/support and antiretroviral therapy for TB programs. Close collaboration is needed to integrate diagnostic, care and prevention services for people affected by both diseases.
Treatment of Multidrug-resistant and Extensively Drug-Resistant Tuberculosis ...WAidid
Slideset by professor G.B. Migliori, Chair of WAidid Working group on Tuberculosis and WHO Collaborating Centre for TB and Lung Disease, Fondazione S. Maugeri, Care and Research Institute Tradate, Italy
Find more on www.waidid.com
This document presents the case of a 35-year-old male patient from Rajasthan, India who is being evaluated for multidrug-resistant tuberculosis (MDR TB). He has a history of pulmonary TB treated one year ago. He now presents with fever, cough, weight loss and weakness. Sputum tests were positive for acid-fast bacilli and resistant to several first-line drugs. He was diagnosed with MDR TB based on drug susceptibility testing. Treatment involves a regimen under India's DOTS Plus program with multiple second-line drugs over 24 months. Management of MDR TB poses clinical challenges including drug adverse effects that require monitoring.
This document discusses the Revised National Tuberculosis Control Program (RNTCP) in India. It summarizes the diagnostic algorithm and treatment categories for pulmonary tuberculosis (PTB) cases. The diagnostic algorithm has been simplified to require a cough for 2 weeks or more and 2 sputum smears, with 1 positive smear sufficient for a diagnosis of PTB. Treatment is categorized based on whether the case is new or previously treated, with Category III phased out. Multi-drug resistant (MDR) and extensively drug resistant (XDR) TB cases are treated under Categories IV and V, respectively.
This document discusses multi-drug resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB). It defines MDR TB as infection by Mycobacterium tuberculosis resistant to at least isoniazid and rifampin, and XDR TB as MDR TB additionally resistant to fluoroquinolones and injectable second-line drugs. Treatment of MDR TB requires using at least four effective drugs, including an injectable agent, while treatment of XDR TB uses third-line drugs to ensure four effective agents. Adherence to multi-drug regimens is important for preventing further resistance.
Multiple Drug Resistance and Antibiotic Misuse In English.Education Front
The report on Multiple Drug Resistance and Antibiotic Misuse.
By: Nadia Hassan, Chandni Yaqoob and Mudassar Iqbal.
School of Biological Sciences, University of the Punjab.
here has been tremendous progress in recent years, and the world is on track to meet the Millennium Development Goal of reversing the spread of TB by 2015. But this is not enough. In 2013, 9 million people fell ill with TB and 1.5 million died.
Clearly, we all need to do more.
The document discusses the benefits of dietary supplements, even for those who are young and healthy. While some believe their diet provides enough nutrients, soil quality has degraded over time, reducing the nutrient levels in foods. Supplements can help restore nutrients missing from modern diets and promote glowing health and feelings of youth.
1. Tuberculosis is an ancient disease that was first recognized in texts from India and Egypt dating back to 1500-1000 BC. Robert Koch discovered the causative bacteria, Mycobacterium tuberculosis, in 1882.
2. Drug resistant TB arises from simple Darwinian selection pressures when bacteria are exposed to antibiotics. Multiple drug resistance develops through the stepwise accumulation of resistance to individual drugs. Improper treatment regimens and non-adherence contribute to the emergence and spread of drug resistant strains.
3. India has a large burden of both drug susceptible and resistant TB. An estimated 220,000 people die from TB in India each year, despite programs that diagnose over 1 million cases annually. The emergence of
The webinar introduces The Nutritional Source website and forum, which provides health and nutrition information. It discusses presenters Nick and Aron's backgrounds and the purpose of helping people improve their health through diet and exercise. The presentation outlines 5 foods to cut out of one's diet, strategies for developing healthy eating habits, finding support for working out, apps to track health goals, and an advanced health and nutrition forum. The forum provides topics on health, nutrition, fitness and more, and costs $59.99 annually with discounts and bonuses included. Q&A is held at the end to discuss the information covered.
The document discusses ways for individuals to save electricity. It notes that energy resources are being depleted and wasted, harming the environment. The document provides tips for conserving electricity at home, such as turning off lights and devices when not in use, closing doors and windows when heating/cooling, using efficient bulbs, and adjusting thermostats. The conclusion encourages everyone to contribute to sustainability efforts to leave a better world for future generations.
We use and waste water every day without realizing how critical it is, as only 2% of the Earth's water is fresh and accessible. Over a billion people lack access to safe water, and water shortages cause millions of deaths each year, mostly among children. Small actions like fixing leaky taps, collecting rinsing water, taking shorter showers, and turning off taps while brushing teeth can help save both water and money while helping address the global water shortage crisis.
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
The document contains 10 quotes related to health and nutrition. The quotes discuss the importance of eating well to think, love and sleep well. They note that some people eat to live while others live to eat. One quote states that one person's preferred food may be poison to another. Overall, the quotes emphasize that health is true wealth and that happiness stems from good health.
Drug resistance occurs when microbes develop the ability to survive exposure to a drug that would normally kill them or limit their growth. There are several mechanisms by which microbes become resistant, including producing enzymes to destroy drugs, altering target sites, reducing drug accumulation, and modifying metabolic pathways. Resistance can be intrinsic, acquired through genetic mutations, or transferred between microbes. Tests like disc diffusion and dilution methods are used to determine antibiotic susceptibility and minimum inhibitory concentrations. Steps must be taken to prevent overuse and misuse of antibiotics in order to slow the development and spread of drug resistance.
Save electricity at home by switching off lights, fans, and gadgets when not in use. Don't leave electronics on standby and use energy efficient monitors and appliances. Use cold water for washing clothes to save 90% of the energy used for heating water. Install timers on water heaters and use economy modes on air conditioners to cut costs and consumption.
This document discusses HIV and pregnancy. It notes that HIV was first identified in 1981 in the US and was reported in India in 1986. Modes of HIV transmission include sexual contact, blood transmission, and perinatal transmission from mother to child. The document outlines the advantages and disadvantages of HIV screening during pregnancy. It discusses the effects of HIV on pregnancy and risks of perinatal transmission. It provides details on management of HIV during pregnancy, delivery, and postpartum care including anti-retroviral regimens to reduce transmission risk. Universal work precautions for healthcare workers are also outlined.
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
This document outlines Ghana's Elimination of Mother-to-Child Transmission of HIV (EMTCT) program. The goals of the EMTCT program are to provide comprehensive services to maintain the health of the mother and prevent transmission of HIV from mother to child. The strategies include primary prevention of HIV in women, preventing unintended pregnancies in HIV-positive women, and preventing transmission during pregnancy, delivery and breastfeeding. The document describes the antenatal, delivery, postpartum and newborn care services provided to support EMTCT, including HIV testing, treatment and infant follow up.
Prevention of Mother to Child Transmission of HIV 2017Helen Madamba
This is a lecture delivered during the Integrated Orientation on HIV/AIDS and TBHIV Collaboration by the Department of Health Region 7 at Bohol Tropics Resort, Tagbilaran City, Bohol
Vertical transmission is major contributor- HIV among children
No intervention – as high as 45%
With interventions – as low as less than 5%
Minimal manipulation
NVD vs. C-section
Anti retroviral prophylaxis vs. anti retroviral therapy
Exclusive breastfeeding vs. exclusive replacement feeding
Follow-up and care.
This is a discussion of hepatitis B, hepatitis C and HIV in pregnancy, the optimal screening for these infections and the integration of management approach based on evidence. Lecture given during the 2018 PIDSOG post-graduate course "High-Yield OBGYN Infections 2.0: From Confusion to Clarity" at the Conrad Manila on November 12, 2018.
This document summarizes guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV in Ethiopia. It outlines the epidemiology of HIV in women and children, defining MTCT and PMTCT. Risks of MTCT are highest without intervention, ranging from 20-45%. The national PMTCT strategy includes: primary HIV prevention; preventing unintended pregnancies in HIV+ women; preventing transmission from mother to child; and treatment, care and support of women and families. Key components are counseling and testing, antenatal care, labor/delivery care, postpartum care, infant care including ARV prophylaxis, and lifelong ART for eligible mothers. National guidelines have opted for WHO PMTCT
This aims to increase awareness on the Philippine HIV Epidemic, how it affects pregnancy and how it can be managed for prevention of mother to child transmission of HIV.
This document summarizes guidelines for preventing mother-to-child transmission (PMTCT) of HIV. It discusses how HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding. The overall transmission rate without intervention is 15-45%, which can be reduced below 5% with effective interventions. These include voluntary counseling and testing for pregnant women, access to antiretroviral treatment for HIV-positive mothers and their infants, safe delivery practices, and guidance on infant feeding options. The document provides details on testing and treatment recommendations during the antenatal, intrapartum, and postpartum periods to reduce HIV transmission from mother to child.
Early initiation of haart why, when and how 21 juneanil kumar g
This document discusses guidelines for early initiation of HIV treatment. It recommends starting antiretroviral therapy (ART) for all people living with HIV, including pregnant and breastfeeding women, regardless of CD4 count or clinical stage. The benefits of early treatment include reduced progression to AIDS, lower rates of illness and death, and decreased HIV transmission. First-line ART regimens preferably include tenofovir, lamivudine and efavirenz. Viral load testing is the best way to monitor treatment response and detect treatment failure.
Early initiation of HAART why, when and how.anil kumar g
This document discusses guidelines for initiating antiretroviral therapy (ART) for HIV, including for pregnant women, children, and prevention. It recommends starting ART for all people living with HIV at a CD4 count of ≤500 cells/mm3. For pregnant and breastfeeding women, the preferred first-line regimen is tenofovir + lamivudine (or emtricitabine) + efavirenz. Early initiation of ART reduces disease progression and transmission risk, and lifelong ART is recommended for all pregnant and breastfeeding women. Simplified regimens help improve treatment access and outcomes for children.
The document provides information on the prevention of mother-to-child transmission of HIV (PMTCT) including its objectives, components, interventions, and guidelines. The key components of PMTCT include testing and counseling, antenatal care including antiretroviral treatment for HIV-positive mothers, safe delivery practices, and guidance on infant feeding options. The overall goal is to reduce the rate of mother-to-child HIV transmission to less than 5% through integrated maternal and child health services.
Consolidated guidelines on
the Use of Antiretroviral
Drugs for Treating and
Preventing HIV Infection
Summary of key features and recommendations
JUNE 2013
Care of HIV positive Pregnant and breastfeeding women_Feb_1_2023.pptxyakemichael
The document provides an overview of prevention of mother-to-child transmission (PMTCT) of HIV, describing its 4 prongs and continuum of services from antenatal care to postnatal care. It aims to eliminate new HIV infections in children and reduce mortality and morbidity in HIV-positive women and their exposed infants. Key interventions discussed include lifelong antiretroviral therapy (ART) for positive mothers, cotrimoxazole prophylaxis, nutrition support, safe delivery practices, early infant diagnosis, and viral load monitoring throughout pregnancy and breastfeeding.
The 2013 consolidated WHO guidelines provide recommendations for treating and preventing HIV across the continuum of care. Key features include:
- Simplified once-daily ART regimens including TDF+FTC/3TC+EFV as the preferred first-line regimen for adults and adolescents.
- "Option B+" is recommended - lifelong ART for all pregnant and breastfeeding women for prevention of mother-to-child transmission.
- Earlier treatment is recommended - ART is to be initiated in all individuals with CD4 ≤500 cells/mm3 or clinical stage 3/4 disease regardless of CD4 count.
This document provides statistics on the global HIV epidemic in 2018 from UNAIDS as well as information on HIV in India. Some key points:
- 37.9 million people globally were living with HIV in 2018. 1.7 million became newly infected that year while 23.3 million were accessing antiretroviral therapy.
- India has the third largest HIV epidemic in the world. In 2015, the national adult prevalence was 0.26%. Prevalence is highest in certain states like Mizoram (2.04%) and Manipur (1.43%).
- Children account for 6.54% of total PLHIV in India. Early infant diagnosis, appropriate infant feeding and prophylaxis
The Role of Maternal Immunization in Reducing Infections in InfantsHelen Madamba
A lecture provided for the Immunization for Filipino Women committee of the Philippine Obstetrical and Gynecological Society, Inc (POGS) and the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) to encourage vaccination for pregnant women in the Philippines
The document discusses the use of social media and media advocacy in health education and public health. It outlines how social media can be used to educate the public, connect healthcare professionals, promote organizations and public health programs, and facilitate patient care and education. However, it also notes dangers like unreliable health information, risks to professionals' images, and privacy violations. The document provides guidance on appropriate social media use and policies to maximize benefits and mitigate risks.
COVID-19 and COVID-19 Vaccination in PregnancyHelen Madamba
As an update to the management of COVID-19 in Pregnancy based on the PIDSOG Handbook, we have the POGS Practice Bulletin on COVID19 Vaccination for Pregnant and Breastfeeding Women. Vaccines work!
- Sepsis and septic shock during pregnancy is a medical emergency that requires specific considerations due to the unique physiological changes of pregnancy.
- A "Sepsis Six" bundle is recommended which includes obtaining cultures, measuring blood lactate, monitoring hourly urine output, providing oxygen, intravenous fluids, and administering antibiotics.
- Management consists of two approaches: resuscitation including fluid resuscitation and source control through removal of infected materials and use of appropriate antibiotics. Scoring systems can help identify at-risk pregnant patients.
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
This is a lecture for medical students of the Cebu Institute of Medicine as an orientation on the prevalence of HIV infection in the Philippines, the basic knowledge on HIV and the program on prevention of mother to child transmission of HIV.
During the time of COVID-19 use of social media in medicine is as relevant than ever and should be maximized by healthcare professionals as a public health tool for health education and promotion to ensure the impact on healthcare is a positive one.
Use of social media for public health promotionHelen Madamba
A short talk with medical technology students of the Velez College for the seminar on "Cyber Etiquette: A Social Responsibility on Health Promotion for the Society" February 15, 2020 from 1pm to 5pm.
As part of the 5th Philippine Healthcare Social Media Summit 2019 #HCSMPH2019 at the Waterfront Hotel in Cebu City, Track B involved choosing platforms for social media depending on one's purpose and based on the target audience.
This document discusses key principles of research ethics including guidelines for authorship, the Nuremberg Code, Declaration of Helsinki, Belmont Report, and Philippine laws and guidelines. Ethical research requires voluntary informed consent, favorable risk-benefit ratio, scientific validity, fair subject selection, and independent review. Research ethics aims to protect human subjects and ensure scientific integrity by applying principles like respect for persons, beneficence, and justice.
This document discusses the social dimensions of sexually transmitted infections like HIV/AIDS. It begins by outlining the objectives of explaining basic HIV/AIDS knowledge. It then discusses the seven dimensions of health, focusing on the social dimension which refers to our ability to interact successfully and maintain supportive relationships. In regards to HIV/AIDS, the social dimension focuses on how social support networks protect against health problems. The document then provides basic information about HIV/AIDS, including what it is, the stages of infection, modes of transmission through body fluids, and methods of prevention through abstinence and safe practices. Statistics about HIV cases in the Philippines are also presented, showing the majority of cases are among young males. The challenges of stigma and lack of
Emerging Issues for Social Workers in dealing with PLHIVsHelen Madamba
This was a talk for ALSWDOPI 2019 at Waterfront Hotel where LGU social workers are challenged to become the government employees who are catalysts of change that the Philippine society needs to address the Philippine HIV epidemic.
These were slides I was not able to use during the lecture I gave for the weekend POGS research workshop because of a mix up in assigned topics. Nevertheless, I think OBGYN residents may find these slides useful in crafting their research proposals.
The document introduces Dr. Helen V. Madamba, who is an obstetrician-gynecologist and infectious disease specialist. It notes her roles as a teacher, mentor, trainer, researcher, social media enthusiast, child rights advocate, and social development worker. The document describes Dr. Madamba as epitomizing a bridge and personifying a catalyst in her various roles in medicine, education, research, and advocacy.
This focuses on the Consensus Recommendations on the Prevention and Management of Surgical Site Infections in the Philippine Setting by Saguil, Bermudez, Antonio and Cochon, PJSS 2017.
Public Health Forum - Social Media in Medicine: Etiquettes for the Modern DoctorHelen Madamba
This lecture introduces reasons why healthcare providers should be on social media and the limits of what we should and shouldn't post on social media, remembering that people are on the other end of the public health conversation.
ConSEXuences: The Devastating Consequences of Sexual IrresponsibilityHelen Madamba
This lecture is part of Adulting 101 Series on Sexual Responsibility, The Ateneo Hearter Way at the Sacred Heart School - Ateneo de Cebu on December 4, 2018 at the Pope Francis Servant Leadership Hall
This is a lecture to raise HIV awareness among the general public. It has been given to the youth in the community, to high school students and even to medical students. It is a simplified way of remembering basic HIV key messages.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
4. Unprotected penetrative sex and IV drug use are
main modes of HIV transmission
March 2015 DOH NEC AIDS registry
MSM
M-F Sex
IVDU
5. July 2014 Philippine HIV and
AIDS Registry
• 585 new HIV cases posted in July
• 36 of the new HIV cases progressed
into full-blown AIDS
• Seventeen deaths due to AIDS were
accounted, and all were male.
http://newsinfo.inquirer.net/633519/585-new-hiv-cases-posted-in-july-17-deaths-recorded-doh
6. Region 10 is #8 in terms of regional
distribution of reported HIV cases
7. Philippine HIV testing centers
on googlemaps
https://www.google.com.ph/maps/search/hiv+testing+center+philippines/@11.6978351,122.6217542,6z/data=!3m1!4b1
8. • There are many other notable
advocates working to stop the
HIV epidemic to achieve the
goal of GETTING TO ZERO:
–zero new infections,
–zero AIDS-related deaths
–zero discrimination.
9.
10.
11. Philippine Obstetrical and Gynecological
Society (Foundation) Inc
Clinical Practice Recommendation on Prevention of
Mother to Child Transmission of HIV Infection
• HIV Screening
• Antiretroviral Drugs
• Management of Delivery
• Infant Feeding
• Contraception
POGS Clinical Practice Recommendations on PMTCT
12. HIV Screening
• Antenatal infections package
– HIV screening
– Hepatitis B virus
– Syphilis
– Rubella
– Urinary tract infection
– Papsmear for HPV
POGS Clinical Practice Recommendations on PMTCT
13. HIV Screening
Preliminary Counselling Dialogue
• Part of thorough assessment of
her status in relation to her
pregnancy
• Routine interview + standard
counselling about HIV
• Strictly confidential
• Opt out - and still receive
the same standard care
POGS Clinical Practice Recommendations on PMTCT
14. HIV Screening
Post-test counselling
If the test is negative
• Recommend repeat test 6 months later
to account for window period
• Counsel patient and her partner to
maintain healthy lifestyle, including low
risk sexual relationship
POGS Clinical Practice Recommendations on PMTCT
15. HIV Screening
Post-test counselling
If the test is positive:
• HIV viral load, CD4 cell count etc
• Antiretroviral drug therapy
• Planned cesarean section scheduled
around 38-39 weeks to avoid labor
and vaginal delivery
POGS Clinical Practice Recommendations on PMTCT
16. HIV Screening
Post-test counselling
If the test is positive:
• Infant formula feeding instead of breast
milk feeding
• Antiretroviral drug therapy for and serial
HIV testing of infant
• Contraception, healthy lifestyle, safe sex
counselling.
POGS Clinical Practice Recommendations on PMTCT
17. HIV Screening
Post-test counselling
If the test is positive:
• Importance of long-term follow up care
• Need to refer to other specialists (e.g.
adult and/or pediatric infectious
disease)
POGS Clinical Practice Recommendations on PMTCT
18. Anti-retroviral (ARV) Drugs
• Anti-retroviral (ARV) treatment and
prophylaxis to prevent maternal-to-child
transmission (MTCT) of HIV
• Determine stage of HIV using WHO
CLINICAL STAGING OF HIV IN WOMEN.
• Determine CD4 cell count
POGS Clinical Practice Recommendations on PMTCT
19. Anti-retroviral (ARV) Drugs
• Determine whether patient requires
ARV treatment or just prophylaxis using
the eligibility criteria based on WHO
clinical stage and CD4 cell count.
POGS Clinical Practice Recommendations on PMTCT
20. Eligibility Criteria for initiating ART or ARV
prophylaxis in HIV-infected pregnant
women based n CD4 count and WHO
clinical stage
WHO CLINICAL
STAGE
CD4 CELL
COUNT NOT
AVAILABLE
CD4 COUNT AVAILABLE
CD4 ≤ 350 CD4 > 350
1 ARV
Prophylaxis
ART ARV
prophylaxis
2 ARV
Prophylaxis
ART ARV
prophylaxis
3 ART ART ART
4 ART ART ART
POGS Clinical Practice Recommendations on PMTCT
21. Anti-retroviral (ARV) Drugs
• Assure initiation and/or maintenance
of antiretroviral therapy (ART) or ARV
• The choice of ARV to be given to a
pregnant patient and her newborn
depends on different clinical scenarios.
POGS Clinical Practice Recommendations on PMTCT
22. Anti-retroviral (ARV) Drugs
Different Clinical Scenarios
• Woman already receiving ARV
treatment for her own health –
continue.
• ARV-naïve HIV-infected pregnant
woman
– With indication for own health, start
ARV regardless of AOG
– ARV prophylaxis started at 14 weeks
AOG
POGS Clinical Practice Recommendations on PMTCT
23. Anti-retroviral (ARV) Drugs
Eligibility for ARV Prophylaxis
• Option A: maternal AZT + infant ARV
prophylaxis
• Option B: maternal triple ARV
prophylaxis until delivery or if
breastfeeding, until 1 week after all
exposure to breast milk ended
• Option B+: start triple ARVs as soon as
diagnosed and continued for life
POGS Clinical Practice Recommendations on PMTCT
24. Anti-retroviral (ARV) Drugs
Advantages of Option B+
• Simplify PMTCT program requirements
– no need for CD4 testing to determine
ARV eligibility
• Extended protection from mother-to-
child transmission
• Strong and continuing prevention
benefit against sexual transmission in
sero-discordant couples and partners
POGS Clinical Practice Recommendations on PMTCT
25. • Option B+’s simplified approach = improvements in
antenatal PMTCT cascade:
– greater proportion ofHIV-infected pregnant women
enrolled into PMTCT services
– increased use of ART during pregnancy
– more rapid initiation of ART
Kim, M. H., Ahmed, S., Hosseinipour, M. C., Giordano, T. P., Chiao, E. Y., Yu, X., … Abrams, E. J. (2015).
The Impact of Option B + on the Antenatal PMTCT Cascade in Lilongwe , Malawi, 68(5), 77–83.
26. Anti-retroviral (ARV) Drugs
Advantages of Option B+
• Earlier treatment for woman’s health
and avoiding risks of stopping and
starting triple ARVs especially in
settings of high fertility
• Simple message to communities
“once ARV started, it
is taken for life.”
POGS Clinical Practice Recommendations on PMTCT
27. Anti-retroviral (ARV) Drugs
• Explain to the
mother that
ARVs can be
procured from
the following
treatment hubs
all over the
archipelago
POGS Clinical Practice Recommendations on PMTCT
29. Management of Delivery
• risks of transmission during delivery
• cesarean section vs vaginal delivery
• antiretroviral drugs through labor
and delivery
• immediate postpartum
care
POGS Clinical Practice Recommendations on PMTCT
30. Management of Delivery
Essential Intrapartum Newborn Care (EINC)
Thoroughly dry newborn infant
× vigorous suctioning
Skin to skin bonding should be
encouraged
× Delayed clamping of umbilical cord is
NOT recommended.
Latching on is done ONLY IF
breastfeeding has been chosen.
POGS Clinical Practice Recommendations on PMTCT
31. Infant Feeding
• avoid breastfeeding, danger of mixed
feeding
• continuing ARV medications
• replacement feeding: acceptable,
feasible, affordable, sustainable and
safe (AFASS)
• risks, follow up and other options for
replacement feeding
• relieve breast engorgement
POGS Clinical Practice Recommendations on PMTCT
32. Contraception
• SAFER SEX is any sexual practice that
reduces the chance of transmitting HIV
and any other sexually transmitted (STIs)
from one person to another
POGS Clinical Practice Recommendations on PMTCT
STI PREVENTION
A – abstinence
B – be faithful
C – correct consistent condom use
D – diagnose and drugs
E – educate
33. Contraception
• Best protection obtained by:
– Correct and consistent use of condoms
during every sexual act
– Choosing sexual activities that do not
allow semen, fluid from the vagina, or
blood to enter the mouth, vagina or
anus of the partner
– Reducing the number of partners
POGS Clinical Practice Recommendations on PMTCT
35. Prevention of HIV Infection of
Health Care Workers
• Standard precautions
• Post-exposure prophylaxis
• Hospital infection control
POGS Clinical Practice Recommendations on PMTCT
36. Prevention of Mother to Child
Transmission of HIV
“Offer HIV counselling and
testing for all pregnant patients
because pregnancy is an
evidence of unprotected
penetrative sex, which is the
most common mode of
transmission for HIV.”
POGS Clinical Practice Recommendations on PMTCT
38. Management of TB/HIV Co-infection
Possible options include the following:
• Defer ART until completion of TB
treatment.
• Defer ART until the completion of
the intensive phase of TB treatment
and then use Ethambutol and
Isoniazid in the continuation phase.
• Treat TB with a Rifampicin-
containing regimen and use
efavirenz + two Nucleoside Reverse
Transcriptase Inhibitors (NsRTIs).
2013 Manual of Procedures for the National TB Control Program. (2013)
39. Global TB Control 2010. Geneva, WHO.
• 1.3 million deaths from TB among HIV-negative people
• 0.4 million deaths from TB among HIV-positive people
http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011-2015.pdf
40. Global Burden of Disease
• 216 500 (95% uncertainty range
192 100–247 000) active
tuberculosis cases existed in
pregnant women globally in
2011.
• The greatest burdens in pregnant
women were in the
– WHO African region - 89 400 cases
– WHO SEAsian region - 67 500 cases
Sugarman, J., Colvin, C., Moran, A. C., & Oxlade, O. (2014). Tuberculosis in pregnancy: an estimate of
the global burden of disease. The Lancet Global Health, 2(12), e710–e716. doi:10.1016/S2214-
109X(14)70330-4
42. • Prevalence of TB in pregnancy
• Effects on Immunity
• TB as a cause of maternal deaths
• Effects of maternal TB infection
and treatment on the neonate
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
43. 1922 – Observations of Dr David Stewart, a medical
superintendent of a women’s TB sanatorium:
1. both pregnancy and TB can have adverse
effects on each other and linked with poor
outcomes
2. outcomes are variable, extremely difficult to
predict early in pregnancy, and management
decisions case-by-case basis
3. special provision made for pregnant women
with TB
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
44. Challenges for TB in
pregnancy
1. the well established epidemiological links
between TB and HIV
2. less clarity and unified mass action with
respect to TB diagnosis and treatment
during pregnancy
3. treating TB in HIV-infected pregnant
women poses huge challenges because
of overlapping toxicities, side effects, pill
burden, changes in tolerability, and the
pharmacokinetics of drugs
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
45. Prevalence of TB in pregnancy
WHO Tuberculosis Report 2014:
• in 2013 there were an estimated
3.3 million cases among women;
• 510 000 deaths;
• a third of these women were co-
infected with HIV
*no mention of “pregnancy”
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
46. Prevalence of TB in pregnancy
• In high-burden countries:
• rates of between 0.07% and 0.5%
were found among HIV-negative
women,
• between 0.7% and 11% among
HIV-positive women
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
47. Effects on Immunity
• women are at increased risk of TB
during pregnancy
• immunological changes associated
with pregnancy present an
opportunity for mycobacterial
infection or re-activation
• pregnant women who are HIV-
positive and have LTBI are more
likely to progress to active TB
disease
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
48. TB as a cause of maternal deaths
Over 50% of pregnant women who
die of TB during pregnancy and
postpartum are HIV-positive.
49. WHO recommendations for
microbiological screening of TB in
pregnancy for high HIV and TB-
burden antenatal clinics:
National TB Programmes (NTPs)
should make a concerted effort to
capture pregnancy-associated TB
and to follow-up on perinatal
outcomes.
M. Bates et al. Perspectives on tuberculosis in pregnancy.
International Journal of Infectious Diseases 32 (2015) 124–127.
50. TUBERCULOSIS ON PREGNANCY
Obstetric complications:
• higher rate of spontaneous
abortion
• suboptimal weight gain in
pregnancy
• preterm labor
• low birth weight
• increased neonatal mortality
Loto, O. M., & Awowole, I. (2012). Tuberculosis in pregnancy: A review. Journal of Pregnancy, 2012.
51. To Treat or Not to Treat?
“Untreated tuberculosis
represents a far greater
hazard to a pregnant woman
and her fetus than does
treatment of the disease”
Centre for Disease Control, “Treatment of tuberculosis,” MMWR, vol. 52, no. RR-11, pp. 1–77, 2003
52. PREGNANCY ON
TUBERCULOSIS
Natural History of TB
Amita, A., Ketan, M., & John, G. (2010). Review Diagnosis
and management of tuberculosis in pregnancy Learning
objectives : Ethical issues :, 163–171.
53. Pregnancy on Tuberculosis
• 111 pregnant women diagnosed
with TB
• Pregnancy had no effect on the
course of TB as regards
– sputum conversion
– stabilization of the disease
– relapse rate
Tripathy SN, Tripathy SN. Tuberculosis and pregnancy. Int J Gynaecol Obstet 2003;80:247–53.
54. CASE FINDING
• Case finding is the identification
and diagnosis of TB cases among
individuals with signs and
symptoms presumptive of
tuberculosis.
55. DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)
1. It provides a definitive
diagnosis of active TB
2. the procedure is simple
3. it is economical; and,
4. a microscopy center
could be put up even in
remote areas.
56. CHEST XRAY
Chest X-ray is used to
complement bacteriologic
testing in making a diagnosis.
However, it has low specificity
and does not differentiate
drug-susceptible from drug-
resistant disease
2013 Manual of Procedures for the National TB Control Program. (2013)
57. The aims of treatment:
• achieve cure without relapse
• prevent progression of the disease
or occurrence of complications
• stop transmission to other
individuals, healthcare professionals
or newborns
• prevent emergence of drug
resistance
Amita, A., Ketan, M., & John, G. (2010). Review Diagnosis and management of tuberculosis in
pregnancy Learning objectives : Ethical issues :, 163–171.
58. DOTS
• All treatment regimens should be
administered under directly
observed therapy (DOT) for the
total duration of the treatment,
within the context of a DOTS
program
59. TB/HIV Co-Infection
• HIV-infected pregnant women
who are suspected of having TB
disease should be treated without
delay.
• TB treatment regimens for HIV-
infected pregnant women should
include a rifamycin.
61. PZA in TB treatment among
pregnant women
• The benefits of a TB treatment
regimen that includes PZA for
HIV-infected pregnant women
may outweigh the undetermined
potential risks to the fetus.
62. Recommended Dosages for Daily
Administration (mg/kg body weight)
Drugs Daily (range) Thrice weekly
(range)
Isoniazid 10
Rifampicin 10 (8-12) 10 (8-12)
Pyrazinamide 25 (20-30) 35 (30-40)
Ethambutol 15 (15-20) 30 (25-35)
2013 Manual of Procedures for the National TB Control Program. (2013)
64. Contraindications
• The following anti-tuberculosis
drugs are contraindicated in
pregnant women:
– Streptomycin
– Kanamycin
– Amikacin
– Capreomycin
– Fluoroquinolones
http://www.cdc.gov/tb/publications/factsheets/specpop/pregnancy.pdf
65. Considerations
• Women who are being
treated for drug-
resistant TB should
receive counseling
concerning the risk to
the fetus because of the
known and unknown
risks of second-line
antituberculosis drugs.
http://www.cdc.gov/tb/publications/factsheets/specpop/pregnancy.pdf
66. • Ascertain whether or not a
woman is pregnant before she
starts TB treatment.
http://thepafp.org/wp-content/downloads/cpg/ntp2013.pdf
67. PREGNANCY
• Most anti-tuberculosis drugs are
safe for pregnant women, except
streptomycin, which is ototoxic to
the fetus.
• Pregnant women taking isoniazid
should be given pyridoxine
(Vitamin B6) at 25mg/day.
2013 Manual of Procedures for the National TB Control Program. (2013)
68. BREASTFEEDING
• A breastfeeding woman afflicted
with TB should receive a full
course of TB treatment.
• Timely and properly applied
chemotherapy is the best way to
prevent transmission of tubercle
bacilli to the baby.
2013 Manual of Procedures for the National TB Control Program. (2013)
69. BREASTFEEDING
• In lactating mothers on
treatment, most anti-tuberculosis
drugs will be found in the breast
milk in concentrations equal to
only a small fraction of the
therapeutic dose used in infants.
2013 Manual of Procedures for the National TB Control Program. (2013)
70. BREASTFEEDING
• It is recommended that lactating
mothers feed their infants before
taking medications.
• Supplemental pyridoxine (i.e.,
vitamin B6) should be given to
the infant who is taking INH or
whose breastfeeding mother is
taking INH.
2013 Manual of Procedures for the National TB Control Program. (2013)
71. Congenital TB
• Few neonates born to mothers
who have active TB disease will
contract TB congenitally
• Congenital TB may be subclinical
or associated with a range of birth
defects.
Bates, M., Ahmed, Y., Kapata, N., Maeurer, M., Mwaba, P., & Zumla, A. (2015). Perspectives on
tuberculosis in pregnancy. International Journal of Infectious Diseases, 32, 124–127.
72. Perinatal TB
• Adjusted perinatal mortality rate
attributable to TB of 65.2/1000
among HIV-infected women
• Maternal TB associated with
increased morbidity, lower birth
weight, and an increased risk of
death
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74. HIV and TB in Pregnancy
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
September 4, 2015
Cagayan De Oro City, Philippines
Editor's Notes
Hi my name is Andrew Pulsipher. I am HIV+ and have been since birth.
Here are the facts about me:
1. I am married to an amazing woman and we will be celebrating our 10 year anniversary this October.
2. I have 3 beautiful children. They are ages 5, 3, and 1 year old.
3. I have been HIV positive for almost 34 years. I can’t say with complete confidence that I am the oldest person living with the disease, but I am pretty sure I am at least one of the oldest living people prenatally infected or born with HIV.
4. Kids who are born with HIV and not treated usually die around age 3 -7. I started taking medication when I was eight.
5. I am currently “undetectable”. No it doesn’t mean I am a ninja. This phrase relates to the amount of virus detectable in my blood, although it still can be hidden in other parts of my body. It also means that the medicine I take every day is working!!!
6. Both of my parents died from AIDS. My dad died when I was 4, my mom when I was 8.
7. None of my brothers and sisters are HIV positive, just my parents and I. The virus will end with me.
8. I grew up with my aunt, uncle and their four children, my “cousins.” I call them my mom, dad, brothers, and sisters because that’s what they are to me.
9. I grew up very rarely telling people I was HIV positive. Only few family members outside of our immediate family and a couple close friends knew. This was to allow as normal of a childhood as possible for me.
10. I am sharing this with you because for the first time I can be completely honest with myself and others. This has taken me a very long time to be comfortable with (almost 34 years!). I know HIV has a negative stigma, but that it doesn’t have to and I want to help change that. It is a treatable disease and you can live a normal life with it. I am proof of that. I want to educate people so that we can get past the “HOW you got the disease” to “HOW you are living your life with it”? There are many miracles in the world and I believe my life is one of them. I am not the only one and we all have stories to tell. If you feel drawn to share my story, please do. I would love to be part of the change in how we talk about HIV. — with Victoria Pulsipher.