Download HIV and Pregnancy - Respiratory Therapy Files

HIV
and
Pregnancy
Introduction
• In the general obstetrical population in the
United States, the frequency of HIV
infection is about 1 per 1000. The
prevalence is as high as 1% to 1.5% in
inner-city populations. Approximately 30%
of the exposed fetuses will also acquire
the infection.
How Can HIV/AIDS Affect Pregnancy?
• In most cases, HIV will not cross through
the placenta from mother to baby. If the
mother is healthy in other aspects, the
placenta helps provide protection for the
developing infant.
• Factors that could reduce the protective
ability of the placenta include in-uterine
infections, a recent HIV infection,
advanced HIV infection or malnutrition.
What Are The Chances That A Baby Will
Become HIV Positive?
• A baby can become infected with HIV in
the womb, during delivery or while
breastfeeding.
• If the mother does not receive treatment,
25 percent of babies born to women with
HIV will be infected by the virus.
Reducing Risk Of Transmission
• A multi-care approach is the most effective
way for pregnant women with HIV infection
to have a healthy pregnancy and delivery.
• The United States Public Health Service
recommends that HIV-infected pregnant
women be offered a combination
treatment with HIV-fighting drugs to help
protect her health and to help prevent the
infection from passing to the unborn baby.
Reducing Risk Of Transmission
• Zidovudine was the first drug licensed to
treat HIV. Now it is used in combination
with other anti-HIV drugs and is often used
to prevent perinatal transmission of HIV.
• ZDV should be given to HIV-infected
women beginning in the second trimester
and continuing throughout pregnancy,
labor and delivery.
• Side effects include nausea, vomiting and
low red or white blood cell counts.
Reducing Risk Of Transmission
• Zidovudine is associated with a decrease
in perinatal HIV transmission to 8.3%.
• When care includes both zidovudine
therapy and a scheduled cesarean
delivery, the risk is approximately 2%.
• Nursing should be discouraged because
the virus is secreted in breast milk.
During Delivery
• The chance of transmission is even
greater if the baby is exposed to HIVinfected blood or fluids.
• Health care providers should avoid
performing amniotomies, episiotomies and
other procedures that expose the baby to
the mother’s blood.
• The risk of transmission increases by 2%
for every hour after membranes have been
ruptured.
During Delivery
• Cesarean sections performed before labor
and/or the rupture of membranes may
significantly reduce the risk of perinatal
transmission of HIV.
• Women who have not received any drug
treatment before labor should be treated during
labor with one of several possible drug
regimens.
• These may include a combination of ZDV and
another drug called 3TC or Nevirapine.
• Studies suggest that these treatments, even for
short durations, may help reduce the risk to the
baby.
Post Delivery
• The baby should be treated with ZDV for the first
six weeks of life.
• Eight percent of babies of women treated with
ZDV became infected, compared with 25
percent of babies of untreated women.
• No significant side effects of the drug have been
observed other than a mild anemia in some
infants that cleared up when the drug was
stopped.
• Follow-up studies show that the HIV-negative
treated babies continued to develop normally.