Pregnancy is a crucial period for every woman. The appearance of the child dramatically transforms the whole family. Immunodeficiency is the factor that can destroy all bright dreams and plans for the future.
Most women do not quite understand why during pregnancy they have to undergo a variety of tests and undergo special diagnostic examinations. Almost everyone is sure that there is no cause for concern, and all these trips to the hospital are a waste of time. However, such self-confidence can be costly.
The fact is that immunodeficiency is a very insidious affliction that for several years can remain in the human body and not in any way impersonate itself. The presence of elevated temperature, an increase in lymph nodes in the background of common symptoms of malaise are usually explained by a banal cold. Only carrying out special laboratory tests allows, with a high probability, to diagnose AIDS in a woman. Therefore, regular examinations by a specialist during pregnancy are a prerequisite to ensure the timely detection of pathology and allow you to make a prediction about whether an HIV-infected person can give birth to a healthy child.
According to scientific research and numerous medical observations, if you do not adhere to preventive measures during the gestation period, approximately 30% of children would be born infected. Thanks to the modern complex of therapeutic measures, today HIV in the maternity hospital in newborns is diagnosed within 2-6% of the total number of infants whose mothers are carriers of the immunodeficiency virus.
If in the process of carrying a fetus a future mother is diagnosed with a disease, it is necessary to understand that pregnancy in this case is a risk factor both for the health of the woman herself and for the future baby.
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- Pregnancy with HIV. How to give birth to a healthy baby?
Despite the fact that the human immunodeficiency virus is a serious and incurable disease, with timely and proper treatment, the life of an infected person can hardly differ from that of a healthy person.
A vivid example of this is the birth of children from HIV-infected parents.
For a start, it is worth knowing that an HIV test for pregnant women is done at the very beginning and during the 30th week of pregnancy. So, that future mother, whose status will be positive, will definitely know about it and will be able to start treatment to reduce the risk of contracting her child. Infection from mother to child can be transmitted in three cases: during pregnancy, for example, through the amniotic fluid or during careless examination, during childbirth, for example, if the child accidentally swallows blood or vaginal discharge of the mother during breastfeeding, which should not be in no case.
Infection during pregnancy can occur at any time, most often - shortly before delivery. The greatest danger arises when the baby is in the womb without amniotic fluid for a long time. But basically the virus enters the child’s body during childbirth. This is confirmed by statistics - this is how 50% of children become infected, 20% - during breastfeeding. Another frightening number: without appropriate treatment, every fourth child born to an HIV-infected mother is infected with a virus.
In addition to the gynecologist, an HIV-positive mother should regularly visit a specialist at an AIDS center. The treatment is carried out with antiretroviral drugs, which, of course, do not completely remove the virus from the body, but help to reduce the viral load, which significantly improves the physical condition of the body and reduces the risk of infection of the child from the mother's body. At the 26th week of pregnancy, an infected woman measures the viral load, CD4, which are responsible for the reaction of the immune system to infections in our body, and, of course, conduct a general and biochemical blood test. And, starting from week 28, special antiretroviral prophylaxis is prescribed. At the same time, it is extremely important to observe the schedule of medication intake and their dosage, since a deviation from the appointed time, or, especially, a missed dosage, may affect the health of the future baby.
If the viral load of a pregnant woman before delivery is 1000 copies / ml, then a woman is prescribed a cesarean section - so the risk of infection is significantly reduced, and in combination with antiretroviral treatment is less than 1%. Also, the risk can be reduced by observing certain rules: to minimize the period when the child is in the womb after the water has withdrawn, to wash the child thoroughly before all necessary medical procedures, and not to put the baby on the mother's breast.
At the same time, we must not forget that the mother’s antibodies are preserved in the child’s body during the first one and a half years of life; therefore, all this time, the exact HIV status of the baby cannot be known. From birth, he undergoes antiretroviral prophylaxis and eats only an artificial mixture, since the mother’s breast milk will infect the infant with the virus. At 18 months, the child is tested, after which his HIV status becomes known and, if necessary, undergoes appropriate treatment. It is important to remember that thanks to ARV therapy, the child is likely to be born healthy and be able to live a full life, pleasing his parents.
How to give birth with HIV?
Can HIV-infected give birth to children? Indeed, in a normal state during pregnancy, the mother’s immune system decreases its activity. In this regard, the additional viral load can significantly complicate both the process of gestation and the subsequent delivery. It should not be forgotten that the risk of infecting a child is large enough. Consequently, infected women should give birth to a baby with full responsibility.
Usually girls with such status are prepared in advance for conception. First of all, they need to register with a specialist and pass tests, on the basis of which the doctor will be able to conclude as to whether it is possible to give birth with HIV in this case. Even if it is 2 births with HIV, the tactics will be exactly the same. Strict adherence to the doctor's recommendations regarding the prescribed antiviral therapy and other preventive measures favors the birth of a healthy baby. In the event that conception turns out to be unplanned, an infected woman has to make a difficult choice between abortion and childbirth. The latter option implies a huge risk that you can have a baby with HIV.
It is also important to take into account that as a result of the examination, there may be a discrepancy between the rhesus and the blood group of the future mother and fetus, which can provoke an immune response and, as a result, fetal death. The presence of Rh-conflict significantly complicates the course of pregnancy. The main signs that indicate such a conflict are general weakness, spasmodic pains in the lower abdomen, nausea and vomiting against the background of general malaise.
Can you give birth with HIV? The mother's body perceives the developing fetus as a foreign body. Accordingly, the immune system must eliminate it. To prevent this, the body purposefully during pregnancy suppresses the vigorous activity of its defense mechanisms. A weakened immune system is thus unable to adequately counteract various pathogens and pathogens. In this regard, a commonplace cold can develop into pneumonia, and the slightest scratch will lead to a strong inflammatory process.
In order to predict how successful HIV delivery may be, a girl needs to undergo a medical examination, which will help determine the state of the immune system and the degree of viral load. Only the availability of such data can provide an answer to the question: is it possible to give birth to a child to an HIV-infected woman?
Can HIV give birth to a healthy child?
A few decades ago, there were active debates in the scientific community about whether it is possible to have children with HIV? Today the situation is unequivocal. A woman can give birth with HIV, but there is a high probability that during the natural course of events the child will be infected. However, the risk of mother-to-fetus transmission is minimized when the pregnancy is monitored by doctors.
The virus enters the baby’s body in the following ways:
- One of the tasks of the placenta is the barrier function. It does not allow germs and viruses to enter the amniotic medium. As a result of a certain imbalance, its protective properties weaken, and the virus can easily enter the infant's body.
- During birth, the baby’s body is in close contact with the mucous membrane of the genital tract of the mother. The slightest injury to the skin increases the likelihood of infection.
- The virus enters the baby’s blood through the stomach or esophagus as a result of swallowing vaginal secretions and mother’s blood.
To avoid infection, it is important to completely eliminate these factors. In addition, there is the likelihood of infection through mother's milk. Risk factors include the appearance of bleeding nipple cracks during breastfeeding. Therefore, women who are born with HIV status, according to experts, should use an artificial mixture to feed the newborn.
Thus, the infection of a baby with a retrovirus can occur:
- in the womb
- during childbirth,
- when breastfeeding.
Delivery of HIV-infected women should be carried out under the supervision of qualified doctors. Only with their help you can save the baby from this disease. The use of antiretroviral treatment in combination with drugs that focus on enhancing the protective mechanisms suggests that the child will be healthy. Childbirth of HIV-infected women is carried out mainly with the help of elective caesarean section to minimize contact of the baby with the mother’s tissues. Due to the fact that there is a high probability of premature discharge of amniotic fluid, pregnant women with such a diagnosis 2 weeks earlier than other women are placed in the prenatal ward.
How to give birth to a child with HIV?
Immunodeficiency virus is a fairly common pathology, which in our days has become an epidemic. Many families are faced with the problems of conceiving a child, especially this topic is relevant for parents infected with a retrovirus. If one or both partners are infected, intimacy becomes difficult and controversial. But this is not a reason for restrictions on sex.
Can you give birth with a child's HIV status if both partners are infected? First of all, the planned pregnancy takes place under the supervision of a doctor and in accordance with its recommendations. With each sexual intercourse increases the risk of re-infection of the mother with other strains of the pathogen. The optimal solution in this situation is artificial insemination. After collecting the semen, it is cleaned of seminal fluid in which the virus is present. And then enter it into the woman's vagina on the day of ovulation.
Is it possible to give birth to an HIV-infected man? If a woman is not infected, sperm purified from seminal fluid is inserted into her vagina on the day of ovulation. An alternative would be to use donor material.
If a woman has HIV and becomes pregnant, how to give birth to a healthy child? When conception occurs unplanned, first of all you need to immediately register with a gynecologist and start antiretroviral treatment to minimize the risk of transmission of the disease to the fetus.
What needs to be done to ensure that HIV delivery is successful?
Due to excessive overload of the immune system during pregnancy, the health of the expectant mother should be protected. Women with HIV give birth to healthy children if they follow prophylactic rules, as well as:
- when the slightest signs of a cold or other infectious disease appear, they are treated,
- refuse to visit public places
- minimize the possibility of injury, scratches, cuts and bruises.
Caesarean and HIV
Natural childbirth in HIV can be safe if a woman has an undetectable viral load. In other situations, in order to reduce the contact of the infant with biological fluids and tissues and thereby reduce the likelihood of transmission of the disease, a caesarean section is performed for HIV infection. In which maternity hospital give birth to HIV status? This question is also of interest to infected patients.
To find out where HIV-infected women give birth, you should ask your doctor. As a rule, such patients receive assistance in a regular maternity hospital. To know where they give birth to HIV, the patient must understand that, according to the law, any infected woman has the same rights as any other woman in labor. None of the maternity hospital has legal grounds to refuse to provide it with medical services.
How HIV-infected women give birth is understandable. To find out that the infant has HIV after delivery is negative, it is necessary to wait for the child to become one and a half years old .. Only at this age can a laboratory test confirm or deny the presence of the disease. In postpartum patients, there is a risk of worsening of the course of immunodeficiency; consequently, they need to pay special attention to their health.
Clinical picture: HIV symptoms in pregnant women
The signs of HIV infection in women during pregnancy do not differ from those in non-pregnant women. After infection in the body, the following stages of the disease proceed successively:
- The incubation period is the time when there are no symptoms and the virus is not detected in the cells of the immune system. Period: from 2 weeks to six months.
- Primary manifestations are often interpreted by a pregnant woman as the common cold. Symptoms: weakness, fever, drowsiness. However, there are cases when the stage is acute. In this case, the symptoms of angina or infectious mononucleosis will be present. After this, an asymptomatic phase occurs, the duration of which happens to reach 10 years.
- Stage of secondary manifestations. Diseases such as Kaposi's sarcoma, pneumonia, fungal infections of the skin and mucous membranes, shingles, seborrheic dermatitis and others occur.
- The terminal stage of HIV infection. It occurs when the number of CD4 cells reaches an extremely minimal value. When this occurs, the defeat of all organs and systems, there are cancer. Any infection that enters the body can be fatal. Life expectancy with this stage rarely exceeds 2 years.
Thus, if a girl feels the slightest signs of a disease that is not related to the course of pregnancy, she should urgently consult a doctor to find out the cause of this condition.
What is HIV
Human immunodeficiency virus is a gradually developing disease characterized by a chronic form of the course. The disease causes damage to the immune system, the central nervous system and other organ systems with the subsequent development of AIDS. The thermal stage of the disease inevitably leads the patient to death.
Attention! A blood test for HIV is given to any pregnant woman when registering at a antenatal clinic.
How can a child be infected
Can a HIV patient have children? How does this affect the woman and child?
If the patient is aware of the disease, she should not assume that HIV during pregnancy will worsen her health. Unpleasant consequences often occur due to the development of secondary ailments and bad habits of women. The virus does not adversely affect the development of the fetus, the main danger is the possibility of infection of the baby during childbirth.
Infection is transmitted from the sick mother to the child in three ways:
- in the period of gestation (intrauterine),
- at childbirth women with HIV infection,
- when breastfeeding.
Children born to HIV-infected mothers who do not take any measures to prevent infection of the baby, in 30% of cases are born sick. If you start the appropriate therapy during pregnancy, the probability of infection of the child is 2-3%.
Thus, children born to HIV-infected mothers are more likely to be healthy.
HIV diagnosis during pregnancy
HIV testing for pregnancy is a group of mandatory measures. How many times during pregnancy do they resort to such a test? Ideally, women planning a pregnancy donate blood for HIV 4 times:
- when planning a child,
- when registering
- in the third trimester,
- after childbirth.
You can take a test for HIV during pregnancy at any time if the woman has not given blood for any reason before.
Анализы крови на вирус у пациенток во время беременности берутся из вены. В некоторых случаях тест на ВИЧ может быть ложноположительным. Такой результат обследования в случае с беременными наблюдается довольно часто.
The reaction to an imaginary virus with a false positive result can be explained by the presence of chronic illnesses in the expectant mother. In addition, the father’s DNA enters the woman’s body, which acts as a virus for the immune system - the amount of antibodies produced in this case is a reason for a positive reaction.
What is the danger of pregnancy for a woman?
What is the price of a healthy woman for a sick woman? How dangerous is pregnancy for an HIV-infected person?
HIV in pregnant women manifests itself similarly to the symptoms of illness in healthy women. However, one should take into account the double effect of weakening the immune system of an HIV-infected patient during the period of carrying a child.
First, the future mother's body “slows down” the immunity to prevent embryo rejection, secondly, the developing disease naturally destroys the protective function of the woman’s body.
Under such circumstances, the risk of developing and acquiring complicated forms of concomitant ailments increases, which the expectant mother cannot avoid.
The body is maintained by a traditional, highly active antiretroviral therapy, which is carried out during pregnancy (from the third month), a few weeks before the birth, the pregnant woman is placed in hospital.
Can an HIV-infected woman give birth to an absolutely healthy child: expert opinion
A healthy baby can be born to an HIV-infected patient. It is possible to give birth to infected women, because the achievements of modern medical science make it possible to reduce the risk of infection of a child born or developing in the womb.
However, it is worth noting that the risk of the birth of a sick baby somewhat increases in pregnant women with the late stage of the disease, as well as those who, against the background of a weakened immune system, have a high viral load.
The risk of infection of the baby also depends on the method of delivery. In the case of a female childbirth, it is possible to have a vaginal delivery (with a viral load of no more than 1000 in 1 μl), however, in order to minimize the risk of infection, abdominal surgery is used.
What care does the mother need during pregnancy?
In most cases, HIV infection in pregnant women does not cause any problems. They need the same prenatal care throughout their pregnancy, as well as healthy expectant mothers. There is no evidence that counseling sick women should occur more often than usual (except in cases with complications).
Starting from the second trimester of pregnancy, patients are prescribed specific therapy.
A HIV-infected pregnant woman may face a number of complications in the process of carrying (giving birth to) a child. So, if a positive test for HIV was not false, a woman from the first months of pregnancy should prepare for preterm labor.
Another obvious consequence of the development of the virus is AIDS, which burdens the pregnancy with various pathologies. A special place in this list of diseases is assigned to viral, fungal, and bacterial diseases. These diseases, depending on the general condition of the body, in pregnant women often occur complicatedly.
And finally, the main complication of pregnancy in an HIV-infected person is transmission of the virus to the baby in the womb, during the birth of the baby by caesarean section or after surgery (natural birth) during breastfeeding.
Conception problems in HIV-positive parents
The possibility of birth of a healthy child from infected parents (or one of them), as we found out earlier, is quite large. However, such couples often face various difficulties. The process of conception in HIV-positive parents requires special attention, and care for the newborn is not carried out in the usual way.
Couples in which only one partner is sick, during sexual intercourse, must use a barrier remedy - a condom. To protect a healthy partner when conceiving a child, there are also special methods and recommendations.
Important! For “special couples”, the question of the possibility of having a child in traditional conditions is alarming. Where do HIV-infected give birth? In each maternity hospital, special blocks are provided for this class of parturient women - here and all the necessary manipulations necessary during the birth process and during the recovery period are carried out.
If both partners are positive
The main danger in the case of HIV-positive status (the presence of acquired immunodeficiency syndrome) of both sexual partners is the effect of infection on the fetus, i.e., infection of the child. There is also a risk of transmitting, in contact with a partner, resistant to treatment varieties of the virus.
Before becoming pregnant, a woman and a man should undergo a full examination, consult with experts to determine the risk of negative viral effects on the fetus.
If the mother is infected
If a woman is infected not from the future father of the child, there is a fact that it is necessary to protect the man’s body from infection. To eliminate the risk of partner infection during pregnancy planning in HIV-positive status, women prefer self-insemination. To this end, the seminal fluid is collected in a container, the expectant mother uses it on days favorable for conception as intended.
When the first signs of pregnancy appear, the patient should consult a doctor for further registration and management of pregnancy.
Among pregnant women may be those who are completely healthy and want to have a child from a sick man. How to be in this situation? What did people come up with to protect mother and baby? Let's move on to the next item.
If father is infected
Are healthy children born of sick fathers? Immediately dispel doubts: a healthy baby can be born to a woman from an infected father.
In such a situation, a high risk of infection of the woman is obvious. To minimize the likelihood of infecting your partner, first, you should not neglect a condom during sexual intercourse. Unprotected sex under similar conditions is permissible only on days favorable for conception. This measure will not only secure the woman, but also allow her to conceive, reducing the risk of infecting the child during the HIV infection of the father.
The second option - the purification of sperm by the method of separation (separation of dead sperm from live). The minus of such a procedure is in its high cost, as well as the possibility of using it only if there is a sufficient concentration of healthy spermatozoa in the patient's seminal fluid.
As mentioned earlier, the baby can become infected when it is born. How not to infect a newborn in the process of childbirth, we describe below.
Prevention of infection of the newborn
With HIV-positive status, the expectant mother needs to know and adhere to a number of recommendations:
- follow all medical instructions. In time to be examined, regularly visit the attending physician,
- eat right and lead a healthy lifestyle. Such an approach is part of the prevention of complications of HIV infection, as well as ensuring the normal development of the fetus,
- observe preventive measures to prevent preterm labor. Premature babies have a higher risk of infection,
- to treat chronic diseases and acute illnesses
- plan a cesarean section for a period of 38 weeks. The decision on the operation is made by a specialist clinic
- refuse to breastfeed. Milk sick mother has a virus in its composition. Alternatively, adapted milk formula is used.
- adhere to prescribed antiretroviral therapy.
How to protect your baby from the virus after birth
A child born to a sick woman is prescribed special drugs to prevent infection, regardless of the specific treatment of the woman during pregnancy.
Therapy begins 8 hours after the end of labor. Till this moment the action of the means that the mother has taken continues. Of great importance is the time interval between the birth of the crumbs and the first dose of the drug. From the moment of the end of labor, no more than 72 hours should pass. Otherwise, the pathogen will attach to the patient's cells.
For young children provides a liquid form of medication. They are introduced through the oral cavity. The following drugs are used: Azidothymidine and Nevirapine (in the dosage calculated by a specialist).
Over the next 18 months, these children are registered. The reason for removing the child from the register can be: the absence of antibodies to the virus, hypogammaglobulinemia and symptoms of the disease.
Every infected woman has the right to decide for herself how much the baby is needed, even if the child has a high risk of contracting the virus. The main thing is that the decision should be balanced and thoughtful.
About the pathogen
The disease causes the human immunodeficiency virus, which is represented by two types - HIV-1 and HIV-2, and many subtypes. It infects the cells of the immune system - CD4 T-lymphocytes, as well as macrophages, monocytes and neurons.
The pathogen multiplies rapidly and within a day infects a large number of cells, causing their death. To compensate for the loss of immunity, B-lymphocytes are activated. But this gradually leads to the depletion of protective forces. Therefore, conditionally pathogenic flora is activated in HIV-infected people, and any infection proceeds atypically and with complications.
The high variability of the pathogen, the ability to cause the death of T-lymphocytes allows you to get away from the immune response. HIV quickly forms resistance to chemotherapeutic drugs, therefore, it is not possible to create a medicine against it at this stage in the development of medicine.
What signs will indicate a disease?
The course of HIV infection can be from several years to decades. Symptoms of HIV during pregnancy do not differ from those in the general infected population. Manifestations depend on the stage of the disease.
At the stage of incubation, the disease does not manifest itself. The duration of this period varies from 5 days to 3 months. Some after two or three weeks have been experiencing symptoms of early HIV:
- flu-like syndrome
- swollen lymph nodes
- slight causeless temperature increase,
- body rash,
- vaginal candidiasis.
After 1-2 weeks, these symptoms subside. The calm period can last a long time. Some take years. The only signs may be recurrent headaches and constantly enlarged painless lymph nodes. Also can join skin diseases - psoriasis and eczema.
Without treatment, after 4-8 years, the first manifestations of AIDS begin. This affects the skin and mucous membranes of bacterial and viral infections. Patients lose weight, the disease is accompanied by candidiasis of the vagina, esophagus, pneumonia often occurs. Without antiretroviral therapy, the final stage of AIDS develops after 2 years, the patient dies from an opportunistic infection.
In recent years, the number of pregnant women with HIV infection has increased. This disease can be diagnosed long before the onset of pregnancy or during the gestational period.
HIV can pass from mother to child during gestation, during childbirth or with breast milk. Therefore, pregnancy planning for HIV should be done in conjunction with a doctor. But not in all cases, the virus is transmitted to the child. The following factors affect the risk of infection:
- the immune status of the mother (the number of viral copies is more than 10,000, CD4 is less than 600 in 1 ml of blood, the ratio of CD4 / CD8 is less than 1.5),
- clinical situation: a woman has an STI, bad habits, drug addiction, severe pathologies,
- genotype and phenotype of the virus,
- condition of the placenta, the presence of inflammation in it,
- gestational age at infection,
- obstetric factors: invasive interventions, duration and complications of childbirth, episiotomy, anhydrous time,
- the condition of the skin of the newborn, the maturity of the immune system and the digestive tract.
The consequences for the fetus depend on the use of antiretroviral therapy. In developed countries, where women with the infection are under observation and follow the instructions, the effect on pregnancy is not pronounced. In developing countries, HIV may develop the following conditions:
- spontaneous miscarriages,
- fetal death,
- joining STIs,
- premature placental abruption,
- low birth weight
- postpartum infections.
Examinations during pregnancy
All women, when registering, give blood for HIV. Repeated research is carried out in 30 weeks, the deviation is allowed up or down for 2 weeks. This approach makes it possible to identify at an early stage pregnant women who have become registered already infected. If a woman becomes infected on the eve of pregnancy, then the examination before childbirth coincides with the end of the seronegative period when it is impossible to detect the virus.
A positive HIV test during pregnancy gives grounds for referral to the AIDS center for subsequent diagnosis. But only one rapid test for HIV does not establish a diagnosis; for this, an in-depth examination is necessary.
Sometimes an HIV test during gestation turns out to be false positive. This situation may scare the future mother. But in some cases, the features of the functioning of the immune system during the period of gestation lead to such changes in the blood, which are defined as false positives. And this may concern not only HIV, but also other infections. In such cases, additional tests are also assigned that allow you to accurately diagnose.
Much worse is the situation when a false-negative analysis is obtained. This can occur when blood is drawn during a period of seroconversion. This is the time when the infection occurred, but antibodies to the virus have not yet appeared in the blood. It lasts from several weeks to 3 months, depending on the initial state of immunity.
A pregnant woman whose HIV test is positive, and further examination confirmed the infection, is offered termination of pregnancy within the statutory deadlines. If she decides to save the child, then further management is carried out simultaneously with specialists from the AIDS Center. The need for antiretroviral (ARV) therapy or prophylaxis is decided, the time and method of delivery is determined.
Plan for women with HIV
Those who became registered as already infected, as well as the identified infection, for the successful carrying of the child must adhere to the following plan of observation:
- When registering, besides the basic planned examinations, an ELISA for HIV is required, as well as an immune blotting reaction. The viral load is determined, the number of lymphocytes CD A specialist from the AIDS Center gives advice.
- At 26 weeks, the viral load and CD4 lymphocytes are again determined, a general and biochemical blood test is performed.
- At 28 weeks, a pregnant woman is advised by a specialist from the AIDS Center, she selects the necessary AVR-therapy.
- At 32 and 36 weeks, the examination is repeated, the specialist of the AIDS Center also advises the patient on the results of the examination. At the last consultation, the term and method of delivery is determined. If there are no direct indications, then preference is given to urgent deliveries through the birth canal.
Throughout pregnancy, procedures and manipulations that disrupt the integrity of the skin and mucous membranes should be avoided. This applies to the amniocentesis and chorionic villus biopsy. Such manipulations can lead to contact of the mother’s blood with the baby’s blood and infection.
When do you need an urgent analysis?
In some cases, a rapid HIV test in the maternity hospital may be prescribed. This is necessary when:
- the patient was never examined during pregnancy,
- only one analysis was submitted at registration, there was no follow-up at 30 weeks (for example, a woman arrives with the threat of premature birth at 28-30 weeks),
- a pregnant woman was tested for HIV at the right time, but she had an increased risk of infection.
Features of HIV therapy. How to give birth to a healthy baby?
The risk of transmission of the pathogen in a vertical way during childbirth is up to 50-70%, with breastfeeding - up to 15%. But these figures are significantly reduced from the use of chemotherapeutic drugs, with the refusal of breastfeeding. With the right scheme, the child can get sick only in 1-2% of cases.
Preparations for antiretroviral therapy for prophylaxis are prescribed for all pregnant women, regardless of clinical symptoms, viral load and CD4 count.
Preventing transmission of the virus to the child
Pregnancy in HIV-infected patients takes place under the cover of special chemotherapy drugs. To prevent infection of the child, use the following approaches:
- prescription of treatment for women who were infected before pregnancy and are planning to conceive,
- use of chemotherapy for all infected,
- during childbirth use drugs for ARV therapy,
- after childbirth prescribe similar medicines for the baby.
Если у женщины произошла беременность от ВИЧ-инфицированного мужчины, то АРВ-терапия назначается половому партнеру и ей, вне зависимости от результатов ее анализов. Лечение проводят в период вынашивания ребенка и после его рождения.
Особое внимание уделяется тем беременным, кто употребляют наркотические вещества и имеют контакты с половыми партнерами с аналогичными привычками.
Treatment at the initial detection of the disease
If HIV is found during gestation, treatment is prescribed depending on the time when it happened:
- Deadline less than 13 weeks. ART drugs are prescribed if there is evidence for such treatment before the end of the first trimester. For those who have a high risk of infection of the fetus (with a viral load of more than 100,000 copies / ml), treatment is prescribed immediately after testing. In other cases, in order to eliminate the negative impact on the developing fetus, it is time until the end of the first trimester with the start of therapy.
- Term from 13 to 28 weeks. When a second trimester disease is detected or an infected woman applies only in this period, treatment is prescribed urgently immediately after receiving the results of tests for viral load and CD
- After 28 weeks. Therapy is prescribed immediately. Use the scheme of three antiviral drugs. If treatment is first prescribed after 32 weeks with a high viral load, a fourth drug may be included in the regimen.
The highly active antiviral therapy regimen includes certain groups of drugs that are used in the strict combination of three of them:
- two nucleoside reverse transcriptase inhibitors,
- protease inhibitor
- or a non-nucleoside reverse transcriptase inhibitor,
- or an integrase inhibitor.
Preparations for the treatment of pregnant women are selected only from groups whose safety for the fetus is confirmed by clinical studies. If it is impossible to use such a scheme, you can take drugs from the available groups, if such treatment is justified.
Therapy in Patients Who Received Previously Antiviral Drugs
If HIV infection was detected long before conception and the expectant mother received appropriate treatment, HIV therapy is not interrupted even in the first trimester of gestation. Otherwise, this leads to a sharp increase in viral load, deterioration of test results and the risk of infection of the child during the gestation period.
With the effectiveness of the scheme used before gestation, there is no need to change it. Exceptions are preparations with proven hazard to the fetus. In this case, the replacement of the drug is made on an individual basis. The most dangerous of those for the fetus is Efavirenz.
Antiviral treatment is not a contraindication for pregnancy planning. It is proved that if a woman with HIV consciously approaches the conception of a child, observes the medication regime, then the chances of giving birth to a healthy baby increase significantly.
The protocols of the Ministry of Health and WHO recommendations identify cases when it is necessary to administer an azidothymidine solution (Retrovir) intravenously:
- If antiviral treatment was not used with a viral load before the birth of less than 1000 copies / ml or more of this amount.
- If the rapid HIV test in the maternity hospital gave a positive result.
- In the presence of epidemiological indications - contact with a sexual partner who has been infected with HIV during the last 12 weeks while injecting drugs.
Choosing a method of delivery
To reduce the risk of infection of the child during childbirth, the method of delivery is determined individually. Deliveries can be carried out through the vaginal delivery in cases when a woman in labor received ART during pregnancy and the viral load at the time of delivery is less than 1000 copies / ml.
Time of use of amniotic fluid is surely noted. Normally, this occurs in the first stage of labor, but sometimes prenatal discharge is possible. Given the normal duration of labor, this situation will lead to a waterless interval of more than 4 hours. This is unacceptable for an HIV-infected mother. With such a dry period, the probability of infecting a child increases significantly. Especially dangerous is the long dry period for women who did not receive ART. Therefore, it may be decided to complete the delivery by caesarean section.
In childbirth with a lively child, any manipulations that violate the integrity of tissues are prohibited:
- vacuum extraction,
- overlay obstetric forceps.
Also do not carry out labor induction and labor enhancement. This all significantly increases the chances of infecting a child. It is possible to conduct these procedures only for health reasons.
HIV infection is not an absolute indication for caesarean section. But to use the operation is strongly recommended in the following cases:
- viral load more than 1000 copies / ml
- unknown viral load
- ART was not performed before the birth or it is impossible to do it in the birth.
Caesarean section completely eliminates the contact of the child with the discharge of the reproductive tract of the mother, therefore, in the absence of HIV treatment, it can be considered an independent method of preventing infection. The operation can be carried out after 38 weeks. Planned intervention is performed in the absence of labor. But it is possible to conduct a cesarean section and for emergency indications.
At birth through the vaginal route, during the first examination, the vagina is treated with a 0.25% chlorhexidine solution.
The newborn after childbirth must be bathed in a bath with 0.25% aqueous chlorhexidine in the amount of 50 ml per 10 liters of water.
How to prevent infection in childbirth?
To prevent infection of the newborn, it is necessary to carry out HIV prevention during childbirth. Preparations are prescribed and administered to the parturient and then born child only with the written consent.
Prevention is necessary in the following cases:
- Antibodies to HIV were detected during testing during pregnancy or with the help of a rapid test in a hospital.
- According to epidemic indications, even in the absence of a test or the impossibility of carrying out, in the case of the use of a pregnant injecting drug or its contact with an HIV-infected person.
The prevention scheme includes two drugs:
- Azitomidine (Retrovir) intravenously, is used from the moment of the onset of labor to cutting the umbilical cord, it is also used within one hour after delivery.
- Nevirapin - one tablet is drunk with the moment of the beginning of childbirth. With the duration of labor for more than 12 hours, the drug is repeated.
In order not to infect a child through breast milk, it is not applied to the breast, either in the labor hall or later. Also, do not use breast milk from the bottle. Such newborns are immediately transferred to adapted mixtures. A woman to suppress lactation is prescribed Bromkriptin or Cabergoline.
The puerperal in the postpartum period, antiviral therapy is continued with the same medications as during the gestation period.
Pregnancy Planning for HIV
In order to become pregnant girl with immunodeficiency, she needs to undergo a full examination in the AIDS center. This is necessary to identify the stage of the process and the possibility of carrying a baby without harm to the female body.
During the examination, it is imperative to determine the viral load. If it turns out to be high, then this indicator should first be reduced with medication, and only then proceed to the planning of pregnancy.
If the blood counts are stable and the woman does not need to receive antiretroviral drugs, then their purpose should not be made in the first trimester of pregnancy due to the strong teratogenic effect.
Before planning a pregnancy for an HIV-infected person, her husband also needs to go to a laboratory, where he will need to be tested for this infection. Based on the results (HIV negative or positive), the possibility of a natural pregnancy is evaluated.
If the sexual partner is not infected, then perhaps the use of artificial insemination methods. To do this, collect the male biomaterial (sperm) and in the laboratory fertilize the female egg. This is necessary in order to eliminate the risk of infecting the husband in the process of conception.
How to control the virus during pregnancy
In order to monitor the immune system of a pregnant woman with HIV infection, the doctor must check the level of the following blood parameters monthly:
- viral load - study of the number of viral copies (the rate of this indicator during pregnancy for a woman with HIV status is 10,000),
- CD4 cells - there should be at least 600 of them in 1 ml of blood,
- The ratio of CD4 / CD8 - not less than 1.5.
Considering the blood counts of an infected woman, a decision is made on the need for antiretroviral therapy, the course of pregnancy, the timing and method of delivery are predicted.
Childbirth in HIV-infected women
Every woman infected with HIV has the opportunity to give birth on her own. The choice of delivery depends on the viral load indicators, which are measured at 36-38 weeks:
- less than 500 copies / ml - natural birth with HIV,
- more than 500 copies / ml is an absolute indication for cesarean section.
Many women are worried: are all children born to infected mothers and can a healthy child be born with HIV? Of course, there is a risk, however, it can be reduced by carrying out the following measures to prevent the transmission of HIV to a baby during childbirth:
- childbirth assessment - partogram,
- minimizing the number of examinations of the birth canal in the process of cervical dilatation,
- rejection of early amniotomy (puncture of the fetal bladder),
- the duration of the anhydrous period during early discharge of amniotic fluid should not exceed 4 hours,
- adequate prevention of bleeding,
- use of antiretroviral therapy during childbirth.
Despite this, at present most of the births in HIV-infected women end up with an emergency cesarean section, since this reduces the perinatal contact of the newborn with the mother's biological fluids. Although this method of childbirth is more traumatic for the mother, however, it reduces the risk of contracting the baby’s virus. The probability of infecting a child during natural childbirth is 6.6%, and for caesarean section less than 1%.
The risk of infecting a child with HIV in pregnant women
In the case of obtaining a positive analysis of a pregnant woman for this infection, it is very important to minimize the risk of this pathology in a child. First of all, it depends on how much adequate therapy she receives.
It is noted that during pregnancy, the lack of treatment for HIV infection leads to a risk of at least 40% of fetal infection. At the same time, if a HIV positive woman receives timely and complete antiretroviral therapy, then the probability of having a healthy child will be about 95%.
Thus, pregnancy and HIV may be compatible. Risks for a newborn baby will be minimized, if immediately after the antibodies to the immunodeficiency virus are detected in a woman’s blood, she will receive the necessary treatment.
Prevention of mother-to-child transmission of HIV
The fact of transmission of the virus to a child can occur in three cases:
- during pregnancy,
- in childbirth
- when breastfeeding.
For the prevention of vertical transmission requires the use of chemotherapy. It can be produced at any stage of pregnancy and childbirth.
During pregnancy, chemoprophylaxis is performed for all HIV-positive women, regardless of the need for antiretroviral therapy. Start of prevention - 14 weeks. If the pathology was revealed at a later date, then prevention should be carried out as soon as possible. To reduce the risk of transmission of the virus to the fetus throughout the pregnancy, Azidothymidine is used, and if it is intolerable, Phosphazide is used.
In the maternity hospital it is necessary to take into account the risk factors of a hospital infection of a child with a HIV-infected woman. If they are minimized, and natural childbirth is possible, then medical prevention is prescribed in the process of obstetrics. For this purpose, several schemes have been developed using the following drugs: Azidothymidine, Nevirapine, Phosphazide.
And also there is a specific chemoprophylaxis for newborns. To do this, the child within 6 weeks after birth should be given Azidothymidine in the form of syrup. An infected mother is strictly forbidden to feed her newborn baby with breast milk.
Summing up, let's answer the question: can a healthy child be born from HIV-infected parents? Of course, yes. But only under the condition that with the help of doctors the risk of transmission of the virus from mother to children will be reduced.
Since, with a positive status, sexual contacts must be protected (with a condom), pregnancy can be problematic.
Somewhat easier if both partners live with the virus, but here there is a risk of sharing its different strains, including those resistant to drugs. In addition, it is believed that the probability of transmission to the child is higher. If the family has HIV only at one, one should try not to infect it.
More difficult if the virus is found only in men. In semen, the concentration of HIV is usually very high, so the danger to women is very likely.
There are several possible solutions:
- reduce the viral load in men to a minimum and choose the ovulation period in women. Unfortunately, this can not completely protect a woman. And infection at conception is dangerous for the baby, because in the first few months of infection the number of viruses in the blood is maximum,
- carry out a special manipulation to clean the sperm from a partner, to separate the sperm from the seminal fluid (the location of the virus). The resulting material is then administered to the woman.
- artificial insemination. The method is quite complicated, expensive and not available to all couples. The isolated individual spermatozoa in vitro are connected to the oocytes obtained from the woman, then the embryos in the early stages of development are introduced directly into the uterus,
- use of donor sperm from special banks. But some men categorically refuse such an opportunity, and for women it is important to give birth to the child’s beloved.
HIV infection and pregnancy - the basic principles of the birth of a healthy baby
Antiretroviral therapy after three months of pregnancy. The safest drug is zidududdinIt is often used in combination with nevirapine.
Observation by doctors, adequate nutrition, prevention of preterm labor. A premature baby (especially with a period of less than 34 weeks) is not able to resist the virus, it is easily infected.
Treatment and Prevention opportunistic diseases of the mother.
Planning the type of birth. Since most babies become infected during labor, a cesarean section at 38 weeks can reduce this chance. But if such an operation has to be resorted to, due to the problems that have arisen, the risk may be even higher.
If it is possible to reduce the concentration of viruses less than 1000 in 1 μl, normal labor also becomes quite safe. Avoid opening the membranes of the fetal bladder, various obstetric manipulations.
No breastfeeding. Prophylactic purpose antiretroviral drugs for newborns in syrups.
To determine whether the child is infected or not immediately after birth is impossible. All HIV tests can be positive for him up to one and a half years of life, because maternal antibodies are in his blood and are destroyed gradually. If after this period the result does not change, then it is infected.
Better late than later
Indeed, for many women it is not clear why they need to be constantly tested for various infections during pregnancy. After all, they have a happy family, and with such a thing exactly can not happen. In fact, pregnancy and HIV very often go hand in hand. Just this disease is very insidious, it can be completely invisible for ten to twelve years. Even if there are a couple of seals (lymph nodes) on the neck, it may go unnoticed. In some cases, the temperature may slightly increase, sore throat, vomiting and diarrhea appear.
In order to identify the disease, we need special laboratory tests. The program of protection of motherhood and childhood must include a thorough examination of the body of the future mother. That is why pregnancy and HIV are two concepts that are often found together. Perhaps, if it were not for an interesting situation, the woman would never go to a doctor.
Can there be a mistake?
Of course it can! That is why it is necessary to pass a further examination, especially if you are confident in your partner. The fact is that the primary diagnosis is carried out using the already indicated ELISA method, which can give both false positive and false negative results. HIV and pregnancy at the same time is a blow for any expectant mother, but it must be remembered that the results obtained are not completely reliable.
A false-negative result may be if the infection has occurred quite recently. That is, the person is already a carrier, but the body has not yet had time to react and develop protection, antibodies, which doctors find. False positive analysis is even more common, especially in pregnant women. The reasons lie in the physiology of this difficult period. Конечно, кому угодно станет не до сна, когда поступит такое известие, однако нужно в первую очередь взвесить, насколько возможно такое развитие событий, какие предпосылки этому были, ну и, конечно, продолжайте обследование.
ВИЧ и беременность могут протекать своим чередом, не слишком влияя при этом друг на друга. Pregnancy does not accelerate the progression of infection in women who are in the early stages of developing the disease. According to statistics, the number of pregnancy complications in this case in infected women is almost no more than that in women without HIV. The only exception is bacterial pneumonia, which is more often diagnosed.
HIV testing during pregnancy is also needed in order to assess the stage of development of the disease. By the way, if we compare mortality with immunodeficiency syndrome, who gave birth and refused it (we are talking about termination of pregnancy after the diagnosis has been made), there are practically no differences.
However, as you already understood, the course of pregnancy very much depends on how long the disease develops, what stage was at the moment of conception, and also on the state of the body. The later the stage, the more complications can occur. This can be frequent and severe bleeding, anemia and premature birth, the birth of a dead child, low birth weight, and postpartum endometritis. Thus, the heavier the disease, the less likely to bear and give birth to a healthy child.
Clinical picture during pregnancy
This moment is especially important for those women who have already learned about their disease during gestation. How does HIV flow during pregnancy, what are the symptoms and treatment of this disease in expectant mothers? These are questions, the answers to which could help many women assess what is happening to them and take adequate measures. But, unfortunately, it is more or less difficult to describe them. The fact is that the immunodeficiency virus develops and progresses against the background of a weakening of the protective functions of the body. And the stronger the immune system retreats under its onslaught, the more pronounced the symptoms will be.
Usually, 6-8 weeks after infection, the person begins to experience the first signs that the expectant mother can easily take for a typical pregnancy picture. At this time, possible increase in fatigue, fever and decreased performance, as well as diarrhea.
What is the main difficulty? This stage does not last long - just two weeks, and the symptoms subside. Now the disease takes a hidden form. The virus enters the stage of persistence. The period can be very long, ranging from two to 10 years. And if we talk about women, then they have a tendency to a long course of the latent stage, in men it is shorter and does not exceed 5 years.
During this period, all lymph nodes are enlarged. This is a suspicious symptom that requires examination. However, here lies the second difficulty: an increase in lymph nodes during pregnancy is normal, and is very common in healthy people. However, this symptom must necessarily alert the future mother. It is better to be safe once again than to lose precious time.
Intrauterine development of crumbs
In this issue, physicians are very interested in one thing, namely, at what time the infection occurs. Much information for this was provided by the tissue of spontaneous miscarriages and infected mothers. Thus, it was found that the virus can cause intrauterine infection in the first trimester, but the probability of this is not too high. In this case, children are born with severe lesions themselves. As a rule, they do not live long.
More than half of all cases of infection occur in the third trimester, the period immediately before birth and the birth itself.
Another interesting fact is that quite recently the detection of antibodies to HIV in the blood of a pregnant woman was an indication for carrying out an immediate termination of pregnancy. This is associated with a high risk of infection of the fetus. However, today the situation has changed. Thanks to modern treatment, a woman is not even sent to a planned cesarean if she receives the necessary treatment.
The probability of infection of the baby
As we know, according to statistics, the immunodeficiency virus is transmitted from mother to child. This is one of the three ways of infection. HIV positive during pregnancy increases the risk of having a baby with a congenital immunodeficiency virus by 17-50%. However, antiviral treatment reduces the likelihood of perinatal transmission of infection to 2%. However, when prescribing therapy, it is necessary to take into account the course of pregnancy. HIV, as we have described, can also be different. Factors that increase the likelihood of transmission to the fetus are:
- late treatment when the disease has reached a late stage
- infection during pregnancy
- complicated pregnancy and difficult childbirth,
- damage to the skin of the fetus during childbirth.
Infection during childbirth
In fact, if the HIV test is positive during pregnancy, you may well give birth to a healthy baby. But he will be born with the mother's antibodies. This means that immediately after birth, the baby will also be HIV-positive. But so far it still means only that his body does not have its own antibodies, but there are only maternal ones. It will take another 1-2 years until they completely disappear from the body of the crumbs, and now it will be possible to say for sure whether the child has become infected.
The future mother should know that HIV during pregnancy can be transmitted to the baby even during fetal development. However, the higher the immunity of the mother, the better the placenta works, that is, the organ that protects the fetus from viruses and bacteria that are in the maternal blood. If the placenta is inflamed or damaged, the probability of infection increases. This is another reason for which it is necessary to undergo a thorough examination with your doctor.
But most often the infection occurs during childbirth. Therefore, pregnancy with HIV infection must be accompanied by compulsory antiviral therapy to minimize this chance. The fact is that during the passage through the birth canal the baby has great chances to come into contact with blood, which dramatically increases the possibility of infection. If you remember from school, this is the shortest way to transmit the virus. Caesarean section is recommended when a large number of viruses are detected in the blood.
As we have said, an HIV test during pregnancy is necessary so that, in the event of a positive result, the mother can undergo complete therapy and maintain her health. During pregnancy, physiological suppression of immunity occurs. Therefore, if the previous study looked only at the gestation period, others went further and found out that after birth the development of HIV could accelerate. Over the next two years, the disease can go into a much more severe stage. Therefore, one cannot rely only on the desire to become a mother. Consultation with a doctor is required at the planning stage. Only such an approach can be your assistant. HIV positive during pregnancy can seriously undermine health, which subsequently leads to a reduction in the quality of life.
Breastfeeding and its hazards
Pregnancy of an HIV-infected person can proceed very well when the baby develops normally and is born completely healthy. Of course, his mother’s antibodies will be contained in his blood, but they may not affect children's immunity. However, now the mother is faced with the choice of whether to feed the baby with breast milk. The doctor must explain that breastfeeding almost doubles the risk of infection. Therefore, abandon it, which will be the best choice. Quality mixes will give your baby a much better chance for the future.
There are a number of factors that may not be in your favor. This is primarily a weakening of the immunity of the mother. High viral load, that is, a large number of viruses in the blood of women - this is also a bad sign. In this case, the doctor may offer to terminate the pregnancy. We have already spoken about breastfeeding - 2/3 of all cases of infection of a child from his mother occur during the first six weeks of life. Multiple pregnancies are also a risk factor.
First of all, the expectant mother should be registered as early as possible. Be sure to follow all recommendations of the attending physician, then you will be more likely to have a healthy baby. Starting from the 14th week, a pregnant woman can take the antiviral drug Azidothymidine or its equivalent. She receives such prophylaxis for free. If a woman for several reasons did not accept it until the 34th week, then it is necessary to begin to do it at a later time. However, the earlier the treatment is started, the less chances the mother has to pass on the disease to her baby.
HIV therapy during pregnancy requires careful weighing of the state of the mother and the duration of pregnancy. That is why leave it to an experienced doctor and in no case try to self-medicate. If you applied to a specialist before pregnancy, at the time of its planning, then, most likely, you will be prescribed combination therapy. The decision to start it is made on the basis of two analyzes - this is the level of DM-4 cells and the viral load. Current treatment requires the simultaneous use of two or more antiviral drugs.
The HIV test (pregnancy is the reason to cancel the combination therapy) is the starting analysis on which all further treatment is based. For the future mother, only one antiviral drug is left to prevent the infection of the crumbs.
If a woman took a combination therapy before pregnancy, then in case of the onset of such, she is recommended to take a break for the first trimester. In this case, the blood for HIV during pregnancy is usually taken three times, and in the specific case the number of samples may increase at the discretion of the physician. The rest of the treatment is prescribed symptomatic. This reduces the risk of the development of malformations of the future baby, as well as avoiding the formidable state of resistance, in which the virus is no longer treatable.
What should a woman remember
Despite the fact that the achievements of modern medicine can reduce the risk of infecting a child from his own mother to 2%, he still exists. Therefore, you need to weigh the pros and cons, because a woman, even being HIV-infected, wants to endure and give birth to a healthy baby. The difficulty is that you will not know whether your baby was born HIV-positive for quite a long time, and it is impossible to predict this in advance. So you have a long and painful waiting. IFA will give a positive result for about 6 months after delivery, so be patient.
Deciding to give birth, a woman should be aware of what awaits her child if he falls into this unhappy 2%. We remind that such a minimal probability of having a baby with an immunodeficiency virus is possible only if the woman did not follow all the recommendations of the doctors, did not undergo regular examinations and did not take the drugs exactly according to the schedule.
The most difficult is HIV infection in those babies who have become infected in utero. Symptoms in this case are much brighter, and often these children do not live up to one year. A smaller number can meet the adolescent period, but to predict their life in adulthood is possible only hypothetically, since so far there have been no such cases.
Infection of HIV during childbirth or breastfeeding is somewhat easier, because the virus already falls on a formed organism with a developing immune system. However, the longevity of the child will be very limited. Usually, doctors do not make a forecast for more than 20 years.
Instead of conclusion
This is a topic about which you can talk endlessly, and still there will be a lot of understatement. HIV diagnosis, like a bad dream, destroys all plans for the future, but it is especially tragic to find out about your diagnosis during pregnancy. In this case, the future mother is faced with a difficult choice and enormous responsibility. Give up your baby or give birth? Will he be healthy or will he endless treatment? All these questions do not have a definite answer. Today we gave you a brief insight, told about the main problems associated with the course of pregnancy in infected women.
Of course, the achievements of modern medicine made it possible to feel the joy of motherhood for a huge number of women. Today, people diagnosed with HIV have believed that they are full-fledged members of society, have the right to family and the birth of healthy children.