prevmothertochildtransofhivppt32-經(jīng)營管理-文庫吧資料
2024-08-24 14:50本頁面
【正文】 minister oral zidovudine 500600 mg/day (100mg PO five times a day, now generally 300 mg twice a day) ? Intrapartum Prescription – During labor and delivery, administer ? intravenous zidovudine 2 mg/kg loading dose over 30 minutes to 1 hour ? followed by continuous infusion of 1 mg/kg/h until delivery ? Newborn Prescription – Within 812 hours of birth, administer oral zidovudine (syrup), 2 mg/kg 4 times daily for 6 weeks – If infant cannot be given oral medication, then administer intravenous zidovudine, mg/kg over 30 minutes every 6 hours 來自 料庫下載 Highly Active Antiretroviral Therapy (HAART) in Pregnancy ? Current US remendations are that optimally all women with HIV be offered HAART because: – MTCT can be prevented if viral load is kept 1000 copies/mL – Available data does not suggest significant risk except for with efavirenz 來自 料庫下載 HAART in Pregnancy ? Pregnant women choosing this option should have their viral load monitored monthly and have their medications adjusted as needed until the virus is undetectable and then every 2 to 3 months. 來自 料庫下載 HAART in Pregnancy ? Mother to child transmission of HIV in in the US is now 2% with this approach. ? Data thus far suggests that these medications are safe in pregnancy except for the NNRTI efavirenz (Sustiva174。 ). 來自 料庫下載 Safety of HAART in Pregnancy ? Nevirapine initiation during pregnancy may need extra monitoring of liver test especially in women with normal CD4 counts ? Protease inhibitors double the risk of gestational diabetes ? Nucleoside analog drugs may have maternal or neonatal mitochondrial toxicities in certain geic groups – Avoid bination of d4T and DDI 來自 料庫下載 Intrapartum management ? Avoidance of – amniocentesis – fetal scalp monitors – artificial rupture of membranes – the use of forceps or vacuum extractor – fetal blood scalp sampling ? Use of prophylactic antibiotics for cesarean delivery to prevent endometritis 來自 料庫下載 Mode of delivery ? Elective ?bloodless? cesarean section decreases transmission by half – In women on no medication transmission rate decreases from 25% to 12% – In women on AZT transmission decreases from 8% to 4% – Probably no effect in women on HAART
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