Mehl. + UW TORCHeS - HIV + NBME 10 77Q. 03-24 (2) Flashcards
Mehl. HIV in pregnancy is HY.
Most important point is that highly active anti-retroviral therapy (HAART) is started immediately in any HIV patient regardless of CD4 count and
that it is three-drug therapy.
Mehl. HIV. what drug avoided in pregnancy?
Efavirenz (an NNRTI) is avoided in pregnancy.
Mehl. HIV. what abs avoided in pregnancy 1st/3rd?
also in women who are trying to conceive.
TMP/SMX even if CD4 count is under 200.
Jis tipo rase kad okay use in 3rd trimester, bet kai ziurejau renal system, tai ten rase kad forbidden in 3rd nes gali sukelti kernicterus.
Mehl. HIV. Intrapartum …… is given to HIV (+) mothers + ….. is performed.
Intrapartum zidovudine is given to HIV (+) mothers + C-section is performed.
Mehl. HIV. …… is given to the neonate within 6-12 hours of birth + given for 6 weeks.
Zidovudine
Mehl. HIV. HIV is present in breastmilk.
It is generally recommended to avoid breastfeeding if
mother is HIV (+).
If the mother’s viral load is undetectable and she is on continued HAART, transmission to neonate might not occur, but it is still advised against.
Mehl. HIV. Zidovudine is given to the neonate within ……
6-12 hours of birth + given for 6 weeks.
UW. HIV. ANTEPARTUM. Testing of HIV-1 viral load how often?
monthly until undetectable, then every 3 months.
UW. HIV. ANTEPARTUM. how often CD4?
every 3 months
UW. HIV. ANTEPARTUM. Resistance testing if not previously perfomed
.
UW. HIV. ANTEPARTUM. What about Tx?
Initiation of HAART
OR
Continuation of HAART
UW. HIV. ANTEPARTUM. what procedure to avoid?
Avoidance of amniocentesis if viral load is detectable
UW. HIV. INTRAPARTUM. avoid what procedures? 3
Artificial ROm, fetal scalp electrode, operative vaginal delivery
UW. HIV. INTRAPARTUM. Viral load ≤50 copies/mL: Mx?
ART + vaginal delivery
UW. HIV. INTRAPARTUM. Viral load >50 to ≤ 1000: Mx?
ART +/- zidovudine + vaginal delivery
buvo tekste: jeigu maziau nei 1000 pries delivery, tai ,,may” deliver without intrapartum zidovudine
UW. HIV. INTRAPARTUM. Viral load > 1000: Mx?
ART + zidovudine + S/c
UW. HIV.
Current guidelines recommend that all pregnant women with HIV begin taking combination antiretroviral therapy (ART) asap, regardless of HIV RNA viral load or CD4 count, to minimize maternal risks of HIV infection and reduce perinatal transmission.
.
UW. HIV.
Drug-resistance testing is performed prior to treatment initiation; however, ART is begun immediately and modified according to results
.
UW. HIV. combination therapy is more effective than monotherapy.
.
UW. HIV. Infants receive postexposure prophylaxis after delivery to further reduce their risk of viral infection.
.
UW. HIV. breastfeeding? if formula available?
Mothers with HIV who live in areas where formula is readily available (eg, the United States) should not breastfeed because HIV can be transmitted through breast milk.
UW. HIV. breastfeeding? if formula not available?
mothers with HIV living in developing countries should continue ART and breastfeed for 6 months to minimize infant morbidity and mortality from other infectious diseases.
NBME 10, 77Q. The risk of intrapartum vertical transmission of HIV may be decreased by (in general)?
by routine maternal HIV testing during pregnancy and by careful planning of delivery.
NBME 10, 77Q. number of copies what has low risk of transmission?
The risk for vertical transmission of HIV in women with viral loads of less than 1000 copies per mL is low in both vaginal and cesarean methods of delivery.
NBME 10, 77Q. Efforts should be made to decrease the amount and duration of contact between the fetus and maternal blood
.
NBME 10, 77Q. Invasive monitoring techniques increase the risk for exposing the fetus to maternal blood and should be avoided. What these procedures??
Placement of fetal scalp electrodes when delivering newborns to HIV-positive mothers for this reason, regardless of the maternal viral load.
NBME 10, 77Q. nfants should receive postexposure prophylaxis with antiviral medications.
.
NBME 10, 77Q. Amnioinfusion incr. risk for vertical transmission in HIV?
NO!!!.
NBME 10, 77Q. Bulb suctioning of the newborn incr. risk for vertical transmission in HIV?
NO!!
NBME 10, 77Q. Determination of umbilical artery pH at delivery incr. risk for vertical transmission in HIV?
NOOO!!
this does not directly prolong the duration of exposure of the newborn to maternal blood or fluids.
NBME 10, 77Q. Intrauterine pressure catheter placement (IUPC) incr. risk for vertical transmission in HIV?
NO!!
may be cautiously used if necessary and if clearly indicated. Few data exist on the risk for vertical transmission associated with IUPC usage, and ACOG recommendations do not provide guidance on their usage.
