HIV in Pregnancy
Dr. ARCHANA VERMA
1) HIV is a retrovirus that can be transmitted from mother to child during pregnancy, childbirth, or breastfeeding. Left untreated, the risk of mother-to-child transmission is 15-45%.
2) Treatment involves antiretroviral therapy for the mother during pregnancy and delivery, and for the newborn for 4-6 weeks to prevent transmission. Mode of delivery and avoiding breastfeeding can also reduce risk.
3) With treatment, the risk of mother-to-child HIV transmission can be reduced to less than 2%. Proper antenatal care, delivery management, and postpartum care and testing of
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
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
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Pregnancy and viral hepatitis by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral infections is not affected by pregnancy.
Jaundice is a characteristic feature of liver disease. The clinical signs and symptoms are indistinguishable between the various forms of viral hepatitis, thus, the differential diagnosis requires serologic testing for a virus-specific diagnosis, [1, 2] and the diagnosis is by biochemical assessment of liver function.
The differential diagnosis includes other forms of viral hepatitis including mononucleosis and Epstein-Barr virus (EBV) infections, autoimmune disease, and widespread systemic infection with liver failure. Patients presenting with jaundice during pregnancy often require a workup to differentiate obstructive gall bladder or bile duct disease, severe preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, low platelet count), or acute fatty liver of pregnancy from viral hepatitis.
The most useful tests to diagnose hepatitis include laboratory evaluation of urine bilirubin and urobilinogen, total and direct serum bilirubin, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), prothrombin time (PT), total protein, albumin, complete blood cell (CBC) count, and in severe cases, serum ammonia.
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
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
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Pregnancy and viral hepatitis by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral infections is not affected by pregnancy.
Jaundice is a characteristic feature of liver disease. The clinical signs and symptoms are indistinguishable between the various forms of viral hepatitis, thus, the differential diagnosis requires serologic testing for a virus-specific diagnosis, [1, 2] and the diagnosis is by biochemical assessment of liver function.
The differential diagnosis includes other forms of viral hepatitis including mononucleosis and Epstein-Barr virus (EBV) infections, autoimmune disease, and widespread systemic infection with liver failure. Patients presenting with jaundice during pregnancy often require a workup to differentiate obstructive gall bladder or bile duct disease, severe preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, low platelet count), or acute fatty liver of pregnancy from viral hepatitis.
The most useful tests to diagnose hepatitis include laboratory evaluation of urine bilirubin and urobilinogen, total and direct serum bilirubin, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), prothrombin time (PT), total protein, albumin, complete blood cell (CBC) count, and in severe cases, serum ammonia.
The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) that causes HIV infection and over time acquired immunodeficiency syndrome (AIDS).
Lab diagnosis of HIV infection/certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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What is HIV? How an HIV infections advances to AIDS? What is AIDS? What are the medicine to stop HIV replication? What are the diagnostic tests? What are the medical managements for AIDS? What are the categories of HIV infection? Symptoms of HIV infection? What should be the nurse care plan for an AIDS patient? How can people prevent HIV infection? All these questions are answered in this presentation.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. INTRODUCTION
– (HIV) Human immunodeficiency virus is a lentivirus (a
member of the retrovirus family) that causes
Acquired Immunodeficiency Syndrome (AIDS)
– Discovered in 1983
– HIV has been divided into two primary strains
• HIV-1 and HIV-2
– HIV is highly a variable virus which mutates very
readily.
3. CHARACTERISTICS OF HIV
HIV is a retrovirus that is believed to have
evolved from a simian immunodeficiency
virus.
Group
Family
Genus
-
Group VI (-ssRNA)
Retroviridae
Lentivirus
HIV can be characterized primarily by its;
• Structure
• Viral genome.
4. STRUCTURE OF HIV
• It is composed of two copies of positive
single-stranded RNA.
• A matrix composed of the viral protein
surrounds the capsid.
• It has a viral envelope
• It has glycoprotein's/receptors on its envelope
6. EPIDEMIOLOGY
WHO estimated that Sub-Saharan Africa remains
by far the worst-affected region, with an
estimated 22.5 million people currently living
with HIV (67% of the global total), and 1.8 million
new infections (69% of the global total).
However, the number of new infections
declined by 19% across the region between 2001
and 2009, and by more than 25% in 22 subSaharan African countries during this period.
Asia is the second-worst affected region, with
4.9 million people living with HIV (15% of the
global total).
7. EPIDEMIOLOGY
The first case of HIV in Ghana was reported in
March 1986.
HIV PREVELANCE BY REGION(%), 2009.
9. ETIOLOGY
The 3 main route of transmission is via;
o blood, blood products
o sexual contact
o mother to child in intrauterine infection,
perinatal transmission, or the mother’s milk.
NB. Infection via saliva or insect bite has not
been confirmed.
10. PATHOGENESIS
Mode of Transmission
o Blood Products
o Blood transfusion
o Infected blood coming into contact with open wounds
o Sexual contact
o Mother to child
o Child birth
o Breast feeding
11. Entry into host cell
o
HIV enters macrophages and CD4+ T cells by the
adsorption of glycoproteins on its surface to receptors
on the target cell.
o
Followed by fusion of the viral envelope with the
cell membrane and the release of the HIV capsid into
the cell.
Replication and Transcription
o On entry of the viral capsid, there is reverse
transcription of the +ssRNA, into a complementary
DNA molecule by the reverse transcriptase.
o The enzyme integrase, integrates the viral DNA into
the host cell genome.
o This integrated viral DNA may then lie dormant, in the
latent stage of HIV infection.
12. Assembly and Release
o Structural proteins, functional proteins and
enzymes are packaged.
o After assembly of the viral particle in the plasma
membrane it buds out of the cell, thus acquiring
an envelope in the process.
13. Stages of Infection
The stages of infection can be grouped into four.
• Stage 1 – Primary
• Short, flu-like illness - occurs one to six weeks
after infection
• no symptoms at all
• Infected person can infect other people
14. • Stage 2 – Asymptomatic
• Lasts for an average of ten years
• This stage is free from symptoms
• There may be swollen glands
• The level of HIV in the blood drops to very low
levels
• HIV antibodies are detectable in the blood
15. • Stage 3 – Symptomatic
• The symptoms are mild
• The immune system deteriorates
• emergence of opportunistic infections and
cancers
Stage 4 - HIV AIDS
• The immune system weakens
• The illnesses become more severe leading to
an AIDS diagnosis
17. Blood Detection Tests
• Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay
(ELISA/EIA)
• Radio Immunoprecipitation Assay/Indirect Fluorescent
Antibody Assay (RIP/IFA)
• Polymerase Chain Reaction (PCR)
• Western Blot Confirmatory test
18. Urine Testing
• Urine Western Blot
– As sensitive as testing blood
– Safe way to screen for HIV
– Can cause false positives in certain people at high
risk for HIV
19. Oral Testing
• Orasure
– The only FDA approved HIV antibody.
– As accurate as blood testing
– Draws blood-derived fluids from the gum tissue.
– NOT A SALIVA TEST!
20. PROGNOSIS
Without treatment, the net median survival time
after infection with HIV is estimated to be 9 to 11
years, depending on the HIV subtype, and the
median survival rate after diagnosis of AIDS in
resource-limited settings is 6 and 19 months.
. In areas where it is widely available, the
development of HAART as effective therapy for
HIV infection and AIDS reduced the death rate
from this disease by 80%, and raised the life
expectancy for a newly diagnosed HIV-infected
person to 20–50 years.
22. Effect of pregnancy on HIV
• CD4 counts fall during pregnancy but return to
pre pregnancy levels post partum.
• No increased risk of accelerated
immunosuppression.
23. Effect of AIDS on Pregnancy
•
•
•
•
•
•
•
Infertility
Repeated abortions
Prematurity
Intrauterine growth retardation
Stillbirths
Congenital abnormalities
Embryopathies
23
24. Antenatal management
• Screening for HIV should be offered early in
pregnancy because appropriate antenatal
interventions can reduce maternal-to-child
transmission of HIV infection.
• positive HIV antibody test result should be
given to the woman in person by an
appropriately trained health professional.
26. multidisciplinary team
HIV positive patients should be managed by a
multidisciplinary team.
• HIV physician
• an Obstetrician
• a Midwife
• a Paediatrician
• a Psychiatric team
• support groups
27. Booking visit
• Additional tests
– Lymphocyte subsets
– Quantitaive RNA PCR measurement of viral load
– Hepatitis B & C
– Cervical & vaginal swabs to check for
STDs,Bacterial vaginosis & Group B streptococcus.
– CD4 count should be tested every trimester or
more frequently if maternal viral load is high.
28. Antenatal care
• Screening for Down syndrome and fetal
anomalies should be offered.
• A detailed ultrasound scan for fetal
anomalies is important after first-trimester
exposure to HAART
29. invasive prenatal diagnosis
• The risk of mother-to-child transmission with
chorionic villus sampling or second-trimester
amniocentesis hasn’t been estabilished.
• If invasive prenatal diagnosis is
contemplated, the advice of the fetal
medicine specialist and HIV physician should
be seeked and prophylaxis with HAART
considered.
31. Antiretroviral therapy
• 2 reasons
– prevention of mother-to-child transmission
(therapy usually discontinued at, or soon after,
delivery)
– secondly for treatment of the mother to prevent
maternal disease progression (therapy continued
indefinitely after delivery)
32. Antiretroviral therapy
• anti-retroviral therapy is recommended for all
HIV positive women during pregnancy and at
delivery to prevent MTCT.
• The optimal regimen is determined by an HIV
physician on a case-by-case basis.
• The decision to start,modify or stop antiretroviral therapy
– should be undertaken by an HIV physician
– in close observation with other health professionals
• obstetrician
• paediatrician.
33. Antiretroviral therapy
• Women who are not on HIV treatment for their own
health need anti-retroviral therapy to prevent mother-tochild transmission.
• Anti-retroviral therapy is usually started between 28 and
32 weeks of gestation and should be continued
intrapartum.
• A maternal sample for plasma viral load is taken at
delivery.
• Maternal anti-retroviral therapy is usually stopped soon
after delivery but the precise time of discontinuation
should be discussed with the HIV physician.
• Zidovudine is usually administered orally to the neonate
for four to six weeks.
34. Antiretroviral therapy
• Timing
– Antenatally
– Intrapartum
– Neonatal period(4-6 weeks)
• Choice of antiretroviral therapy & Timing is
decided by HIV physician.
• Plasma viral load & CD4 counts regularly
monitored.
35. Antiretroviral therapy......
• Patients on antiretroviral therapy should be
monitored for toxicity
•
•
•
•
•
full blood count
urea and electrolytes
liver function tests
Lactate
blood glucose
• Patients should also have detail ultrasound
scan to detect foetal anomalies.
36. Drug toxicity
• Presentation with symptoms or signs of
• pre-eclampsia
• Cholestasis
• other signs of liver dysfunction during pregnancy
– may indicate drug toxicity
37. Lactic acidosis
– is a recognised complication of certain HAART
regimens.
• presenting symptoms
• often nonspecific
• include
–
–
–
–
gastrointestinal disturbance
fatigue
fever
breathlessness.
38. Types of HIV drugs
• Reverse transcriptase inhibitors
– Nucleoside reverse transcriptase inhibitors
– Non nucleoside reverse transcriptase inhibitors
• Protease inhibitors
• Entry inhibitors
• Integrase inhibitors
39. Prophylaxis of Pneumocystis carinii
• PCP prophylaxis is usually administered when
the CD4 T-lymphocyte count is below 200
• The first line treatment is cotrimoxazole(a
folate antagonist).
• Folic acid 5 mg should also be given
• Nebulised pentamidine is another alternative.
40. Screening for genital infections
• All pregnant women who are HIV positive
should be screened for genital infections.
• When to do ?
• This should be done as early as possible in pregnancy
• repeated at around 28 weeks.
• Any infection detected should be treated.
41. Mother to child transmission
• Non breast feeding women in Europe 15-20%
• Breast feeding mothers in Africa 25-40%
• Breast feeding is associated with 2 fold
increase in transmission.
42. Prevention
• Maternal child transmission is prevented by
– Antenatal HIV screening
– Antiretroviral therapy
– Elective Caesarean section
– Avoiding breast feeding
– Reduced from 25-30% to less than 2 %
43. Prevention of MTCT
• 2 choices of antiretroviral therapy
– Single agent-Zidovudine
– START(short term antiretroviral therapy)
• HAART for short duration in pregnancy and continued
intrapartum
44. Zidovudine Vs START
Zidovudine
START
may allow the emergence of resistant
virus
maternal plasma viraemia is more likely to
be suppressed to undetectable levels
exposure of the mother and fetus to
larger numbers of potentially toxic drugs
45. advanced HIV
• likely to have symptomatic HIV infection and
– a falling or low CD4 T-lymphocyte count less than
350
– And / or a high viral load (greater than 10 000–20
000 copies/ml).
46. advanced HIV
• These women should be treated with a
HAART regimen.
• The start of treatment should be deferred
until after the first trimester, if possible, and
should be continued after delivery.
47. advanced HIV
• Women who conceive while taking HAART
should continue their HAART regimen if it is
effectively suppressing plasma viraemia.
• For women whose regimen is not
suppressing viraemia, a change in therapy
after the first trimester may be indicated.
48. Mode of delivery
• Elective Caesarean section is beneficial
– HIV positive women who are not taking HAART
during pregnancy
– for women with a detectable plasma viral load
• Value of elective caesarean section is
uncertain
– in women taking HAART who have an
undetectable plasma viral load at the time of
delivery.
49. LSCS in HIV women
• A zidovudine infusion
– should be started four hours before beginning the
caesarean section
– Should continue until the umbilical cord has been
clamped.
• A maternal sample for plasma viral load should
be taken at delivery.
• The cord should be clamped as early as possible
after delivery and the baby should be bathed
immediately after the birth.
50. LSCS in HIV women....
• a technique of ‘bloodless’ caesarean section
may further reduce the risk of mother-tochild
transmission.
– opening the uterus with a staple gun,which
simultaneously cuts and giveshaemostasis.
51. Casarean section
• This should be sheduled at 38 weeks to
reduce the risk of spontaneus labour or
membrane rupture.
• Contamination of the baby with maternal
blood should be avoided
– Secure the bleeding points
• Cord clamped as soon as possible
52. Casarean section
• Drainage should be used and they should be
used to closed suction system
• Universal precautions :gloves, aprons & face
protection should be employed.
53. Labour in HIV woman
• Women who opt for a planned vaginal delivery should have their
membranes left intact for as long as possible.
• Use of fetal scalp electrodes and fetal blood sampling should be
avoided.
• Women should continue their HAART regimen throughout labour .
• If an intravenous infusion of zidovudine is required it should be
commenced at the onset of labour and continued until the
umbilical cord has been clamped.
• A maternal sample for plasma viral load should be taken at
delivery.
• The cord should be clamped as early as possible after delivery and
the baby should be bathed immediately after the birth.
54. Vaginal delivery
• Forceps preferred to Vacuum
• Remove maternal blood stain with alcohol
wipe prior to Vitamin K injection
• Universal precautions :gloves, aprons & face
protection should be employed.
55. SROM in HIV
• SROM-spontaneus rupture of Membranes
– ruptured membranes for more than four hours ,
associated with double the risk of HIV
transmission.
– These studies also demonstrated a 2%
incremental increase in transmission risk for every
hour of rupturedmembranes up to 24 hours.
– The relevance of these studies for women taking
HAART who have undetectable viral loads is
uncertain.
56. PPROM in HIV
• PPROM-preterm prelabour rupture of
membranes
– If there is preterm rupture of membranes, with or
without labour, the risk of HIV transmission
should be set against the risk of preterm delivery.
– Preterm infants are more likely to be infected with
HIV.
– There is no known contraindication to the use of
short-term steroids to promote fetal lung
maturation.
57. Postpartum
• women with HIV advised not to breast feed
• Neonate infections.
– PCR is done as maternal antibodies cross the placenta
– Typically, tests are carried out at birth, then at three
weeks, six weeks and six months.
– definitive test is the HIV antibody test: a negative result at
18 months of age confirms that the child is uninfected.
58. Management of the neonate
• All infants born to women who are HIV
positive should be treated with antiretroviral therapy from birth.
• Usually treatment is discontinued after four
to six weeks
59. Recommendation for for HIV-infected
mother in labor who had no prior
therapy
1. Single dose Nevirapine during labor and a
single dose to the neonate at age 48h.
2. Intrapartum AZT, the 6 weeks of AZT to the
neonate.(2mg/kg 4 times daily)
3. The two dose Nevirapine combined with
the intrapartum and 6 weeks AZT regimen.
60. • IN case of maternal HIV antiretroviral
resistance:
AZT is still recommended to the infant, plus
other medications based on maternal HIV
resistance pattern.