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    Presentation Aids and Hiv

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    Lamnunnem Haokip

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    Presentation Aids and Hiv

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    Lamnunnem Haokip
    91 views27 pages

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    91 views27 pages

    Presentation Aids and Hiv

    Uploaded by

    Lamnunnem Haokip

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    HIV / AIDS DURING

    PREGNANCY

    UNDER THE SUPERVISION


    PRESENTED BY: OF
    LAMNUNNEM HAOKIP DR. SHANTI IDA
    MSC (N) 2ND YEAR PROF.CUM HOD (OBG)
    SNSR, SU SNSR, SU
    INTRODUCTION

    • Human Immunodeficiency Virus (HIV)


    causes an incurable infection that leads
    ultimately to a terminal disease called
    Acquired Immunodeficiency Syndrome
    (AIDS).
    • Worldwide 25 – 30% of infected patients are
    women and 90% of them are 20 – 49 years
    of age.
    DEFINITION

    • Human Immunodeficiency Virus (HIV) : It


    belongs to retrovirus family which is the causative
    agent of Acquired Immunodeficiency Syndrome
    (AIDS).
     
    • Acquired Immunodeficiency Syndrome
    (AIDS): A disease in which there is a severe loss
    of the body's cellular immunity, greatly
    lowering the resistance to infection and
    malignancy.
    IMMUNOPATHOGENESIS

    • The target for HIV is the CD4 receptor molecule.


    • Cells within the immune system that have this
    molecule are : CD4+ T lymphocytes, monocytes,
    macrophages and other antigen presenting cells
    like fibroblasts, neurons, renal, hepatic and
    intestinal cells.
    • Following infection, there is profound cellular
    immunodeficiency as the CD4+ are progressively
    depleted by cytopathic effects of HIV.
    Immunological markers that are used to
    determine the progression of the disease are as
    follows:
    • CD4 T lymphocytes count – patients with count
    from 200 – 300 cells/mm3 are likely to have HIV
    related symptoms and count <200 cells/mm3 is
    taken into AIDS defining criteria.
    • Measurement of HIV RNA levels by RT-PCR and
    the bDNA assays.
    MODE OF TRANSMISSION

    • Multiple partners, prostitution.


    • IV drug abusers
    • Multiple transfusion of blood and blood
    products
    • Parent to child
    CLINICAL PRESENTATION

    Acute infection syndrome is characterized by:

    • Fever

    • Skin rash

    • Arthralgia

    • Lymphadenopathy

    • Diarrhoea - This is called seroconversion

    illness. It lasts less than 2-3 weeks and

    resolves spontaneously.
    AIDS related complex refers to subjects
    having nonspecific clinical features like:
    • Weight loss

    • Fever, diarrhoea, herpes simplex, oral or


    recurrent genital candidiasis, oral or genital
    ulcers.
    • Pelvic Inflammatory Disease
    • Tubo-ovarian abscess.
    • Thrombocytopenia.
    PARENT TO CHILD TRANSMISSION

    • Vertical transmission to the neonates is about


    14 – 25%.
    • Trans-placental transmission occurs 20%
    before 36 weeks and over 80% of transmission
    around the time of labour and delivery.
    • Vertical transmission is more in cases with
    pre-term birth and with prolonged membrane
    rupture.
    • Risks of vertical transmission are directly
    related to maternal viral load and
    inversely to maternal immune status.
    • Maternal Antiretroviral Therapy reduces
    the risk of vertical transmission by 70%.
    • The maximum risk of transmission form
    parent to child is the peri-partum period
    and intra-partum period.
    PREVENTION OF PARENT TO CHILD
    TRANSMISSION :

    Guidelines by National AIDS Control


    Organization (NACO):

    • HIV testing is recommended in all pregnant


    women which is opt-out approach.

    • Antiretroviral therapy is recommended for all


    HIV positive women irrespective of their CD4
    counts.

    • Vaginal delivery is recommended, Caesarean


    section is not the only option.
    INTERVENTION RISK OF HIV
    TRANSMISSION
    FROM MOTHER
    TO CHILD
    No intervention and 30 – 45%
    continue breastfeeding

    No ART and stop 20 – 25%


    breastfeeding

    ART and continue 2%


    breastfeeding

    ART and no 1%
    breastfeeding
    PROPHYLAXIS ON
    ANTIRETROVIRAL THERAPY(ART)
    • Initiate antiretroviral therapy in pregnancy as
    soon as diagnosed with HIV positive. Once
    started, it should be life-long.

    Starting ART for the first time: Triple drug


    regime:

    • Tenofovir – 300 mg

    • Lamivudine – 300 mg

    • Efavirenz – 600 mg (considered safe in pregnancy


    in all the trimester by world health organization).
    Women already on Antiretroviral Therapy

    • If the mother is already on ART, she should continue


    the regime.

    Recommendations for delivery

    • Vaginal delivery

    • Caesarean section for obstetric indications.

    • Minimize the vaginal examination

    • Avoid early rupture of membrane.

    • Avoid prolonged labour (Oxytocin can be used).

    .
    • Avoid routine episiotomy.
    • Avoid unnecessary instrumentation

    • During post-partum, methergine is


    avoided because ART drugs and
    methergine potentiates increase risk of
    hypertension.
    • According to world health organization,
    there is no rush in early cord clamping.
    Recommendations for Infant Prophylaxis
    • After birth the infant should also get ART
    prophylaxis irrespective of the mode of feeding
    of the infant (breastfed and replacement fed
    babies).
    • Mother who has taken ART more than 4 weeks
    during pregnancy, the infant should be given
    Syrup Nevirapine for 6 weeks after delivery /
    birth.
    • Mother has taken ART less than 4 weeks
    during pregnancy, the infant should be
    given Syrup Nevirapine for at least 12
    weeks.
    • For a mother who took Nevirapine in the
    past or previous pregnancy, for the infant
    Syrup Zidovudine.
    STANDARD SAFETY MEASURES

    Prenatal Care:
    • Screening should be offered voluntarily.
    • Counselling about the risks of HIV
    transmission from parent to child.
    • Tuberculin test should be test to find out
    any associated factors which can leads
    to HIV/AIDS.
    Intra-partum Period

    • Avoid instrumentations during labour.

    • Careful handling of fluids of the mother.

    • Use of personal protective equipment.

    Post-partum Period

    • Counsel regarding the breastfeeding and


    help to informed choice.

    • Keeping the perineal area clean with


    antiseptic solutions to prevent infections
    The followings are the safety measures to prevent form
    transmission of HIV/AIDS from one person to another:
    • HIV testing and linkage to care, HIV medications and
    Access to condoms
    • Prevention programs for people with HIV and their
    partners
    • Prevention programs for people at high risk for HIV
    infection
    • Substance abuse treatment and access to sterile syringes
    • Sexually Transmitted Infections screening and treatment.
    • Use of personal protective equipments.
    SUMMARY
    &
    CONCLUSION
    BIBLIOGRAPHY / REFERENCE
    • DC Dutta’s. Hiralal Konar. Textbook of
    Obstetrics. 8th Edition. Jaypee The Health
    Sciences Publishers. Page no. 350 – 353.
    • Anamma Jacob. A cComprehensive Textbook of
    Midwifery and Gynaecological Nursing. Fourth
    Edition. Jaypee The Health Sciences Publishers.
    Page no. 321 – 323.
    • DC Dutta’s Hiralal Konar. Textbook of
    Gynaecology. 7th Edition. Jaypee the health
    sciences publishers. Page no.126 – 128.
    • Park K. Park’s Textbook of Preventive and
    Social Medicine, twenty fifth edition. Banarsidas
    Bhanot Publishers; page no. 310 – 8.
    • https://youtu.be/xIOqLQGQthQ
    • https://www.acog.org/womens-health/faqs/hi
    v-and-pregnancy#:~:text=During%20pregna
    ncy%2C%20HIV%20can%20pass,breaks%2
    0(her%20water%20breaks)
    .
    • Royal College of Obstetricians and
    Gynaecologists, Royal College of Midwives,
    Royal College of Anaesthetists, Royal
    College of Paediatrics and Child Health.
    Standards for Maternity Care. Report of a
    Working Party. London: RCOG Press; 2008
    [http://www.rcog.org.uk/
    womens-health/clinical-guidance/standards-
    maternity-care].

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