Loading....
Coupon Accepted Successfully!

OBG

Open Flashcards

Medical and Surgical Complications in Pregnancy

Question
39 out of 45
 

HIV transmission from mother to the baby can be minimized by following except: (AIPG 2011)



A Antepartum Zidovudine therapy to mother and to the neonate after birth

B Maternal Vitamin A therapy

C Vaginal delivery

D Avoidance of breast feeding

Ans. C

Vaginal delivery

1. HIV Infection in pregnancy

a. The predominant cause of HIV infection in children is transmission of the virus from the mother to the newborn during the perinatal period.

b. Exposures, which increase the risk of mother-to-child transmission, include vaginal delivery, preterm delivery, trauma to the fetal skin, and maternal bleeding.

Additionally, recent infection with high maternal viral load, low maternal CD4+ T cell count, prolonged labor, prolonged length of membrane rupture, and the presence of other genital tract infections, such as syphilis or herpes, increase the risk of transmission.

c. Breast-feeding may also transmit HIV to the newborn and is therefore contraindica- ted in most developed countries for HIV-infected mothers.

d. There is no clear evidence to suggest that the course of HIV disease is altered by pregnancy. There is also no clear evidence to suggest that uncomplicated HIV disease adversely impacts pregnancy other than by its inherent infection risk.

e. RX:

f. The majority of cases of mother-to-child (vertical) transmission of HIV-1 occur during the intrapartum period.

g. Mechanisms of vertical transmission include infection after rupture of the membranes and direct contact of the fetus with infected secretions or blood from the maternal genital tract.

h. Zidovudine (ZDV) administered during pregnancy and labor and to the newborn reduces the risk of vertical transmission by 70%.

i. Cesarean section is associated with additional risk reduction compared to vaginal delivery, especially in women with a viral load >1000 copies/mL.

j. Regardless of the mode of delivery, intrapartum ZDV should be provided.

2. WHO guidelines for PMTCT drug regimens in resource-limited settings:

PREGNANCY

LABOUR

AFTER BIRTH: MOTHER

AFTER BIRTH: INFANT

Recommended

AZT after 28 weeks

single dose nevirapine; AZT+3TC

AZT+3TC for seven days

single dose nevirapine; AZT for seven days

Alternative (higher risk of drug resistance)

AZT after 28 weeks

single dose nevirapine

-

single dose nevirapine; AZT for seven days

Minimum (less effective)

-

single dose nevirapine; AZT+3TC

AZT+3TC for seven days

single dose nevirapine

Minimum (less effective; higher risk of drug resistance)

-

single dose nevirapine

-

single dose nevirapine

3. Effective prevention of mother-to-child transmission (pmtct) requires a three-fold strategy:

a. Preventing HIV infection among prospective parents

b. Avoiding unwanted pregnancies among HIV positive women

c. Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.

d. The last of these can be achieved by the use of antiretroviral drugs, safer infant feeding practices and other interventions.

4. Maternal-Fetal/Infant Transmission of HIV infection:

a. The predominant cause of HIV infection in children is transmission of the virus from the mother to the newborn during the perinatal period.

b. Exposures, which increase the risk of mother-to-child transmission, include –

i. Vaginal delivery,

ii. Preterm delivery,

iii. Maternal bleeding, and

iv. Trauma to the fetal skin.

c. Additional factors that may increase the risk of transmission include:

i. Recent infection with high maternal viral load,

ii. Low maternal CD4 T cell count, prolonged labor,

iii. Prolonged length of membrane rupture, and

iv. The presence of other genital tract infections, such as syphilis or herpes.

d. One important study demonstrated that a single dose of nevirapine given to the mother at the onset of labor followed by a single dose to the newborn within 72 h of birth decreased transmission by 50% compared with a regimen of zidovudine to the mother that began at the onset of labor and continued throughout labor and to the infant for 1 week following birth.

e. In women with HIV infection who are not receiving antiretroviral therapy, the rate of vertical transmission is approximately 25%.

f. In a meta-analysis, zidovudine treatment of both the mother during the prenatal and intrapartum periods and the neonate at birth reduced the risk of vertical transmission to 7.3%.

g. The combination of elective cesarean section plus zidovudine treatment reduced the risk of vertical transmission to 2%.

h. Truncated regimens of zidovudine alone or in combination with lamivudine given to the mother during the last few weeks of pregnancy or even only during labor and delivery, and to the infant for a week or less, significantly reduced transmission to the infant compared to placebo.

i. Short-course prophylactic antiretroviral (ARV) regimens, such as a single dose of nevirapine given to the mother at the onset of labor and a single dose to the infant within 72 h of birth, are of particular relevance to low- to mid-income nations because of the low cost and the fact that in these regions perinatal care is often not available and pregnant women are often seen by a health care provider for the first time at or near the time of delivery.

j. Indeed, short-course ARV regimens have now been used for several years in developing nations for the prevention of mother-to-child transmission.

Medical and Surgical Complications in Pregnancy Flashcard List

45 flashcards
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
40)
41)
42)
43)
44)
45)