Medicine an Surgery notes

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MTCT, PMTCT INTERVENTIONS,PEPDr. Ongech JohnKenyattaHospital/NairobiUniversityLearning ObjectivesMTCT of HIVMagnitude and Impact of MTCT of HIVFactors influencing MTCT of HIVPMTCT ARVsHAART in PregnancyPMTCT services and special issues(PEP)MAGNITUDE OF MTCTWhat is MTCT?Prevalance-Pregnant women 12.3%(urban)7.5% ruralWomen(15-49yrs)-8.7%,Men 4.5%133,000 births per year from HIV + women53,000 HIV positive infants yearlyTiming of MTCTDuring Pregnancy-5-10%During labor 10-20%Pregnancy+Labor = 15-30%Breastfeeding 18-24 months-10-15%Preg.+Labor+BF= 25-45%IMPACT of MTCTIncreasing IMR1989- 60/1000 births2003- 78/1000 birthsFactors influencing MTCTMaternal Factors High Viral load Low CD4 count Micronutrient deficiency Vitamin A deficiency AnaemiaMTCT Factors.Maternal factors.. STDs Multiple sexual partners Malaria New infection during pregnancyObstetric and Delivery factorsHow does the transmission occur? Baby sucks the maternal blood with HIV Baby sucks cervical secretion with HIV Maternal fetal- blood mixing(placenta sep.)Vaginal delivery or C/S?Obstetric risk factorsPROM more than 4 hoursVacuum extraction/Forceps deliveryARMEpisiotomiesFrequent vaginal examinationsChorioamnionitisExtensive lacerationsCord Milking/Delayed clumpingProlonged lab

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