BY A.Narendra G.S.L Medical College Rajahmundry

1. Mother to child transmissionof HIV and Breast feeding A. Narendra Roll.no. 1

2. HIV can Spread through : 2 Transfusion of infected blood/ blood produts 3 Sharing of contaminated needles/syringes 4 Infected mother to child 1 Unprotected sex with an infected person

3. Mother To Child Transmission Of HIV Problem statement About 2% of HIV cases reported in India have acquired the infection through mother to child transmission In India prevalence rate of HIV is more than 1% among ANW in states of Maharashtra Karnataka TamilNadu, Andhra Pradesh, Manipur, Nagaland. ( High Prevalence states)

4. High Prevalence States Maharashtra Karnataka Tamil Nadu, Andhra Pradesh, Manipur, Nagaland.

5. Mother to child transmission Mothers with HIV can transmit virus to their infants during pregnancy, childbirth and breast feeding.

6. Risk of transmission is more during child birth

7. Maternal Risk factors for Mother to child transmission during pregnancy and delivery MTCT Obstetrical Child Viral

9. A low birth weight baby is at higher risk

10. Mixed feeding increases the risk

11. Early rupture of membranes increases the risk Obstetrical factors First born among twin pregnancy

13. During child birth During pregnancy When we can take measures to prevent child to mother transmission During breast feeding Before pregnancy

14. IEC activities Family planning Counseling & testing Primary preventive strategies Prevention of getting HIV infection among mothers , before they become pregnant Delivery of FP services more extensively Education the adolescent girls about reproductive health , safe sex and consequences of sexual behaviour Referring to ICTC Indentify HIV infected women in antenatal period

15. Secondary preventive strategies Multivitamin supplementation Avoid invasive procedures Anti retroviral therapy Measures to reduce or prevent the risk of transmission during pregnancy and child birth to reduce the risk of LBW. amniocentesis, aminoscopy, fetal scalp electrodes etc. Measures of PMTCT during pregnancy:

16. Avoid invasive procedures The procedures that either increase the chance of the mother bleeding or may cause breaks in the skin of the fetus through which there may be direct contact with the mother’s blood or vaginal secretions will increase the risk of transmission of HIV from mother to child. These procedures can increase risk of transmission. Amniocentesis Aminoscopy Fetal scalp electrodes Fetal sampling

17. Zidovudine Anti-retroviral therapy various regimens are recommended. 300mg twice a day for the full course of pregnancy from the second trimester may be initiated. Another regimen: ZDV 300mg bd from 34th week of pregnancy till delivery].

18. Measures of PMTCT during child birth: Antiretroviral therapy Prevention of premature rupture of the membranes Mode of delivery Care of the new born

19. Zidovudine Antiretroviral therapy during child birth ZDV 300mg ,three hourly during delivery; If the mother is brought during labor and if there is no H/o ART during pregnancy , she is given 200mg Nevirapine [NPV]as a single dose at the onset of labor. This reduces the risk of transmission from 35% to 12%. Under PPTCT programmeNevirapine is given

20. Prevention of premature rupture of the membranes Recent studies showed that the risk of mother-to-child transmission increased 2% each hour after membranes ruptured. Mode of delivery Cesarean section before labor and/or rupture of membranes reduces risk of mother-to-child transmission by 50–80% compared with other modes of delivery No evidence of benefit with cesarean section after onset of labor or membranes have been ruptured Cesarean section, however, increases morbidity and possible mortality to mother

21. Mode of delivery If at all vaginal delivery/home delivery has to be conducted due to constraints of resources like hospital or experts or equipments or money, it should be conducted carefully by the health personnel, preferably by avoiding episiotomy. If at all the episiotomy is given, it needs to be sutured as early as possible to reduce the risk of occupational exposure.

23. Take care! Minimal use

24. Suturing: Use appropriate needle and holder

25. Care with recapping and disposal

26. Wear gloves, wash hands with soap immediately after contact with blood and body fluids

27. Cover incisions with watertight dressings for first 24 hours

28. Use:

29. Plastic aprons for delivery

30. Goggles and gloves for delivery and surgery

31. Long gloves for placenta removal

32. Dispose of blood, placenta and waste safelyPROTECT YOURSELF!

33. Gloves Before touching blood , body fluids, mucus membranes, non intact skin or performing venepuncture Dispose of needles with syringes and sharp instruments in puncture resistant container Hand washing Wash hands immediately with soap after gloves are removed Do not recap needles or otherwise manipulate by hand before disposal Mouth piece of resuscitator bags should be available to minimize need for emergency mouth to mouth resuscitation Masks & protective eye ware shields from splashes of blood or body fluids, Waste and soiled material should be disposed properly Gown/apron For produres likely to generate splashes of blood or body fluids,

35. Inexpensive method of feeding and contraception.

38. If the woman is:

39. HIV-negative or does not know her HIV status, promote exclusive breastfeeding for 6 months

40. HIV-positive and chooses to use replacements feedings, counsel on the safe and appropriate use of formula

41. HIV-positive and chooses to breastfeed, promote exclusive breastfeeding for 6 months

43. 27 Results Risk of transmission in: 156 newborns who were never breastfed: 18.8% (95% CI 12.6–24.9) 288 newborns who were breastfed and formula fed: 24.1% (95% CI 19.0–29.2) 103 newborns who were exclusively breastfed: 14.6 (95% CI 7.7–21.4) Conclusion: Newborns who were exclusively breastfed for at least 3 months did not have any excess risk of HIV infection compared to newborns who were not breastfed

45. Family planning

46. Counseling & testing

47. Multivitamin supplementation

48. Avoid invasive procedures

49. Anti retroviral therapy

50. Antiretroviral therapy

51. Prevention of premature rupture of the membranes

52. Mode of delivery

53. Care of the new born

54. Counseling

55. Maternal nutrition

56. Exclusive breast feeding

58. The programme entails counselling and testing of pregnant women in the ICTCs. Interventions Pregnant women who are found to be HIV positive are given a single dose of Nevirapine at the time of labour Newborn babies also get a single dose of Nevirapine immediately after birth