7. hiv dalam kehamilan

7/28/2019 7. HIV Dalam Kehamilan

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HIV and Pregnancy 2

Pembahasan

Ante natal yang baik,

pertolongan intrapartum, dan post

partum ibu dengan HIV (+) untukmengurangi transmisi dari ibu ke

janin.


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HIV and Pregnancy 3

Pregnancy Effects on HIV

Pada semua wanita, CD 4

menurun pada semua pasien HIV

(+) ( Kehamilan tidak membuatHIV semakin buruk )

Pada ibu hamil dengan HIV (+),

CD 4 dan Viral Load tidak

berubah karena kehamilan.


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HIV and Pregnancy 4

Komplikasi kehamilan pada pasien HIVPregnancy

Outcome

Relationship to HIV Infection

Spontaneousabortion

Limited data, but evidence of possibleincreased risk

Stillbirth No association noted in developed

countries; evidence of increased risk in

developing countriesPerinatal mortality No association noted in developed

countries, but data limited; evidence of

increased risk in developing countries

Newborn mortality Limited data in developed countries;evidence of increased risk in

developing countries

Intra-uterine

growth retardation

Evidence of possible increased risk

Anderson 2001.


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HIV and Pregnancy 5

Pregnancy

Outcome

Relationship to HIV Infection

Low birth weight Evidence of possible increased risk

Preterm delivery Evidence of possible increased risk,especially w/ more advanced disease

Pre-eclampsia No data

Gestational

diabetes

No data

Amnionitis Limited data; more recent studies do not

suggest an increased risk; some earlier

studies found increased histologic placental

inflammation, particularly in those with

preterm deliveries

Oligohydramnios Minimal data

Fetal malformation No evidence of increased risk

Anderson 2001.


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HIV and Pregnancy 6

Transmisi dari ibu ke janin

2535% ibu hamil dengan HIV

positive akan menularkan pada

janin yang dikandungnya Bila tidak menyusui :

30% transmisi saat hamil70% transmisi saat persalinan

Meta-analysis : 14% transmisi saat

menyusuiDeCock et al 2000; Dunn et al 1992; WHO/UNAIDS 1999.


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HIV and Pregnancy 7

Faktor resiko penularan dari ibu

ke janin Viral load (HIV-RNA

level)

Infeksi genital

Jumlah CD4

Clinical stage of HIV

Multipartner seksual

Merokok Narkoba

Defisiensi Vitamin A

Penyakit menular

seksual

Pemberian

Antiretroviral TersalinanPreterm

Solusio Placenta

Lama Ketuban pecah Vaginal delivery vs.

cesarean section

BreastfeedingAnderson 2001.


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HIV and Pregnancy 8

Intervensi untuk mengurangi transmisi dari ibu ke janin :

Test HIV saat hamil

Antenatal care

Pemberian Antiretroviral

Intervensi Obstetrik :

Hindari amniotomi

Hindari tindakan : Ekstraksi Forceps/vacuum

Hindari episiotomi Seksio sesarea elektif/berencana

Pencegahan infeksi

Newborn feeding: Breastmilk vs. formula


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HIV and Pregnancy 9

Test saat hamil

Keuntungan :

Memungkinkan penatalaksanaan pada ibu

Menurunkan resiko transmisi dari ibu ke janin

n

Mencegah penyebaran lebih lanjut

Bila negative, konseling tentang pencegahan

penularan

Counseling is important!


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HIV and Pregnancy 10

Antenatal Care

Sebagian besar ibu HIV (+) :

asymptomatic

Kenali gejala HIV/AIDS dan komplikasi

saat hamil

Obati PMS dan infeksi lain

Hindari unprotected intercourse Hindari tindakan invasif dan versi luar

Berikan antiretroviral agents

Konseling tentang nutrisi.


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Antiretrovirals

Zidovudine (ZDV):

Long course

Short course

Nevirapine

ZDV/lamivudine (ZDV/3TC)


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ZDV Perinatal Transmission Prophylaxis

Regimen: ACTG 076 Trial

Antepartum Initiation at 1434 weeks gestation andcontinued throughout pregnancy

PACTG 076 regimen: ZDV 5 times

daily

Acceptable alternative regimen: ZDV 2or 3 times daily (depending on dose)

Intrapartu

m

During labor, ZDV IV over 1 hour,

followed by a continuous infusion of IV

until delivery

Postpartu

m

Oral administration of ZDV to newborn

for first 6 weeks of life, beginning at 8

12 hours after birth


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Intrapartum vs. Postpartum Regimens for HIV-Infected Women in

Labor with No Prior Antiretroviral Therapy

Drug

Regimen

Maternal

Intrapartum

Newborn Postpartum Data on

Transmission

Nevirapine One oral dose

at onset of

labor

One oral dose at age

4872 hours (if

mother receivednevirapine < 1 hour

before delivery,

newborn given oral

nevirapine as soon

as possible after

birth and at 4872

hours)

Transmission at 6

weeks 12% with

nevirapinecompared to 21%

with ZDV, a 47%

(95% CI, 2064%)

reduction

Anderson 2001.


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Intrapartum vs. Postpartum Regimens

for HIV-Infected Women in Labor with

No Prior Antiretroviral Therapy (contd.)

Drug

Regimen

Maternal

Intrapartum

Newborn

Postpartum

Data on

Transmission

ZDV/3TC ZDV orally atonset of labor

followed by

dose orally

every 3 hours

until delivery

AND

3TC orally at

onset of labor,

followed by

dose orally

every 12 hours

ZDV orally every12 hours

AND

3TC orally every

12 hours for 7

days

Transmission at6 weeks 10%

with ZDV/3TC

compared to

17% with

placebo, a 38%

reduction

Anderson 2001.


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Intrapartum vs. Postpartum Regimens for HIV-Infected Women in

Labor with No Prior Antiretroviral Therapy (contd.)

Drug

Regimen

Maternal

Intrapartum

Newborn

Postpartum

Data on

Transmission

ZDV IV bolus, followed

by continuous

infusion of everyhour until delivery

Orally every 6

hours for 6

weeks

Transmission 10%

with ZDV

compared to 27%with no ZDV

treatment, a 62%

(95% CI, 19-82%)

reduction

Anderson 2001.


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Intrapartum vs. Postpartum Regimens

for HIV-Infected Women in Labor with

No Prior Antiretroviral Therapy (contd.)

Drug

Regimen

Maternal

Intrapartum

Newborn

Postpartum

Data on

Transmissi

onZDV and

Nevirapi

ne

IV bolus, then

continuous

infusion until

deliveryAND

Nevirapine

single oral

dose at onset

of labor

Orally every 6

hours for 6

weeks

ANDNevirapine

single oral

dose at age

4872 hours

No data

Anderson 2001.


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Prosedur Obstetric

Karena peningkatan eksposure janin

terhadap darah dan sekresi ibu akan

meningkatkan transmisi ke janin melaui :

Amniotomi

Fetal scalp electrode/sampling

Ekstraksi Forceps/vacuum

Episiotomi

Robekan Vagina


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Delivery: Cesarean vs. Vaginal

Birth Resiko transmisi dari ibu ke janin meningkat 2%pada setiap jam setelah ketuban pecah

Seksio sesarea sebelum inpartu/ketuban pecah

menurunkan resiko transmisi dari ibu ke janin

5080% dibandingkan dengan cara persalinanlain.

Tidak ada bukti kegunaan seksio sesarea

setelah inpartu/ketuban pecah

Seksio sesarea meningkatkan angka morbiditas

dan mortalitas ibu

Berikan antibiotik profilaksis sebelum seksio

sesarea.


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Rekomendasi untuk

Pencegahan Infeksi Jarum :

Hati-hati ! Minimal use

Penjahitan luka : Gunakan jarum dan needle

holder yang tepat.

Hati-hati saat menutup jarum dan

membuangnya.

Gunakan sarung tangan, cuci tangandengan sabun segera setelah kontak

dengan darah dan cairan tubuh lain.


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Rekomendasi untuk

Pencegahan Infeksi Gunakan :

Plastic aprons untuk menolong persalinan

Kaca mata dan sarung tangan untuk

menolong persalinan dan operasi

Sarung tanga panjang untuk manual plasenta

Buanglah darah, plasenta, dan benda

terkontaminasi lain dengan aman.

PROTECT YOURSELF!


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Bayi baru lahir

Basuh bayi baru lahir, khususnya bagian

muka.

Hindari hipotermia

Berikan obat anti retroviral ( Bila tersedia)


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Breasfeeding

Menghangatkan bayi baru lahir.

Nutrition for newborn

Protection against other infections Safety unclean water, diarrheal diseases

Risk of HIV transmission

Contraception for mother


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Breastfeeding

RecommendationsIf the woman is:

HIV-negative or does not know her HIV

status, promote exclusive breastfeeding

for 6 months

HIV-positive and chooses to use

replacements feedings, counsel on the

safe and appropriate use of formula

HIV-positive and chooses to breastfeed,

promote exclusive breastfeeding for 6

months


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Conclusion

Voluntary counseling and testing

Antenatal, intrapartum and postpartum

care to mother can decrease risk of

mother-to-child transmission

Antiretroviral therapy can also reduce risk of

transmission

Newborn care: Feeding

7. hiv dalam kehamilan

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