Preventive measures for mother-to-child transmission of AIDS. Application of Antiretroviral Drugs
For pregnant women who are HIV-positive during pregnancy, two relatively independent but closely related issues must be considered at the same time: one is antiviral treatment of HIV infection, and the other is to reduce the risk of mother-to-child transmission. When treating pregnant women with antiviral drugs, we must weigh the impact of antiviral drugs on pregnant women, fetuses and newborns. Considering drug resistance and toxic side effects, the World Health Organization currently recommends the following preventive medication schemes for pregnant women infected with HIV who have not received antiviral treatment, which can be selected according to pregnant women and local actual conditions.
Scheme 1: pregnancy+puerperal period+postpartum newborn (AZT+NVP combined medication) (recommended medication)
Pregnant women take zidovudine (AZT)300mg orally twice a day from the 28th week of pregnancy until labor. During delivery, take 300 mg HAZT orally every 3 days until the end of delivery; Pregnant women take 200 mg of villi (NVP) after delivery. If the pregnant woman does not give birth after 24 hours, she will be given a repeated dose of villi 200 mg after delivery. If elective cesarean section is needed, diazepam 200mg should be taken 2 hours before operation. Take diazepam 2ms/kg once within 72 hours after birth, with a maximum of 6mg. Take AZT/Kloc-0 once every 6 hours after birth, with 2mg/kg. If the mother takes AZT for 4 weeks or more, the baby takes AZT 1 week. If the pregnant woman takes medicine for less than 4 weeks, the baby should take medicine for 6 weeks.
Scheme 2: Pregnancy+Puerperal Period+Postpartum Newborn (AZT Scheme)
Pregnant women take zidovudine (AZT)300mg orally twice a day from the 28th week of pregnancy until labor. During delivery, take 300 mg HAZT orally every 3 days until the end of delivery; After the baby is born, take AZT/KLOC-0 every 6 hours, 2ms/kg. If the mother takes AZT for 4 weeks or more, the baby takes AZT 1 week. If the pregnant woman takes medicine for less than 4 weeks, the baby should take medicine for 6 weeks.
Scheme 3: Pregnancy+Puerperal Period+Postpartum Newborn (AZT+3TC combined medication)
Pregnant women take zidovudine (AZT)300mg+ lamivudine (3tc)150mg twice a day from the 36th week of pregnancy to labor. Zidovudine 300mg 65438+ 0 times every 3 hours+Lamivudine 150mg twice a day, during the delivery until the end of the delivery; Puerperal women were given zidovudine 300mg twice a day and lamivudine 150mg twice a day for a total of 1 week. Neonatal zidovudine 4ms/kg twice a day+lamivudine 2ms/kg twice a day 1 week.
Scheme 4: Delivery Period+Postpartum Newborns (Viagra Scheme)
Pregnant women should take 200mg of Viagra (NVP) once after delivery. If pregnant women still do not give birth after 24 hours, they should take 200 mg of Viagra repeatedly after delivery. If elective cesarean section is needed, diazepam 200mg should be taken 2 hours before operation. Within 72 hours after birth, the baby takes Viagra 2ms/kg (or suspension 0.2ml/kg) at a time, with a maximum of 6mg(0.6m 1). If the newborn vomits within 1h after taking diazepam, it should be taken again.
Preventive measures for mother-to-child transmission of AIDS II. Postpartum prevention
Provide postpartum routine health care and follow-up for HIV-infected people, and carry out counseling, psychological support and comprehensive nursing services. Vitamin A deficiency and anemia are common among women infected with HIV, and both diseases are related to vertical transmission from mother to child. It is suggested that women should eat a nutritious diet during pregnancy and lactation. All pregnant women should be supplemented with trace elements such as iron, folic acid and zinc. Women should take high doses of vitamin A after delivery. Women infected with HIV should be included in the follow-up management of the local comprehensive AIDS prevention and control system after delivery.
For the health care of babies born to HIV-infected mothers, we should strengthen the care of HIV-infected mothers and their babies, provide feeding guidance, routine child health care, monitor growth and development, prevent malnutrition and enhance physical fitness.
Because breast-feeding will increase the chance of mother-to-child transmission of AIDS, mothers infected with HIV should be helped to weigh the advantages and disadvantages of breast-feeding and artificial feeding on the basis of full consultation, and make the correct feeding mode choice after the baby is born. Advocate artificial feeding, try to avoid breastfeeding and never mix feeding. Pregnant women infected with HIV should be provided with consultation, selection and implementation of infant feeding plans, intervention measures to prevent HIV transmission through breast milk and family planning services. Correct selection and implementation of infant feeding measures include exclusive breastfeeding, alternative feeding or shortening breastfeeding time, while reducing infant susceptibility. Guiding correct feeding techniques and paying attention to breast protection during breastfeeding, chapped nipples, mastitis and breast abscess obviously increase the risk of HIV transmission through breast milk.
Babies should be tested for HIV antibody in 12 months. If the result is negative, the infection will be excluded and included in normal child care. The positive patients were followed up to 18 months, and HIV antibody was detected again. Negative results exclude infection and are included in normal child health care. Results The positive infants were transferred to the local comprehensive AIDS prevention and control system.
Vaccinate according to the normal planned immunization program. If the baby has clinical symptoms of AIDS, all other vaccines should be vaccinated according to the normal vaccination procedure except BCG.
Preventive measures for mother-to-child transmission of AIDS. health education
Health education on the prevention of mother-to-child transmission of AIDS has been widely carried out, and the coverage of health education in prenatal clinics, pregnant women's schools, wards and delivery rooms, premarital health clinics, village clinics, schools and other places has been expanded in various forms, and a health education network on the prevention of mother-to-child transmission of AIDS has been established.
Through health education activities, the knowledge and information on prevention of mother-to-child transmission of AIDS will be transmitted to pregnant women, their families and pre-marital health care groups, and the ability of service personnel to carry out health education on prevention of mother-to-child transmission of AIDS will be improved, and health education materials will be developed and produced to guide the distribution and use of materials in health education activities.
All relevant institutions should set up a hotline to prevent mother-to-child transmission of AIDS (or add the content of preventing mother-to-child transmission of AIDS to the hotline) and provide relevant consulting services.
Preventive measures for mother-to-child transmission of AIDS. Strengthen health care during pregnancy.
Provide health education and consultation for pregnant women infected with AIDS and their families, improve their own and their families' understanding of AIDS and prevention of mother-to-child transmission of AIDS, so that they can fully understand the harm of HIV infection through mother-to-child transmission to themselves and their unborn babies, and make informed choices about pregnancy outcomes.
For pregnant women infected with HIV who require termination of pregnancy, induced abortion should be carried out as soon as possible to reduce the occurrence of complications. Provide induced abortion service for those who decide to terminate pregnancy and give effective contraceptive guidance.
In order to provide routine pregnancy care, monitoring and follow-up for pregnant women infected with HIV who request to continue pregnancy, it is suggested and encouraged that pregnant women should have regular pregnancy check-ups and provide special psychological support and comprehensive nursing services for infected pregnant women.
Give advice and health care on excellent pregnancy, excellent education, health care during pregnancy, preparation for breastfeeding during pregnancy, application of antiviral drugs during pregnancy and delivery, and postpartum infant feeding, and take corresponding preventive intervention measures.
Infected pregnant women are prone to malnutrition, so nutrition monitoring and guidance should be strengthened. Understand the history of pregnancy and delivery, whether there are complications and complications, and previous delivery methods. And understand the history of other diseases and the application of drugs (especially antiviral drugs). Close observation of possible symptoms and signs, prevention and active treatment of pregnancy complications, reproductive tract infections and sexually transmitted diseases.