7. hiv dalam kehamilan
TRANSCRIPT
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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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HIV and Pregnancy 11
Antiretrovirals
Zidovudine (ZDV):
Long course
Short course
Nevirapine
ZDV/lamivudine (ZDV/3TC)
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HIV and Pregnancy 12
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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HIV and Pregnancy 13
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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HIV and Pregnancy 14
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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HIV and Pregnancy 15
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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HIV and Pregnancy 16
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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HIV and Pregnancy 17
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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HIV and Pregnancy 18
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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HIV and Pregnancy 21
Bayi baru lahir
Basuh bayi baru lahir, khususnya bagian
muka.
Hindari hipotermia
Berikan obat anti retroviral ( Bila tersedia)
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HIV and Pregnancy 22
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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HIV and Pregnancy 23
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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HIV and Pregnancy 24
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