- Email: [email protected]
Mother to infant transmission
TUESDAY,
SEPTEMBER
7
5
provide access to legal abortion had had minimal success in Brazil up to 1997, when only three public hospitals provided such services. In November of 1996, the Center for Maternal and Child Research of Campinas (CEMICAMP) organized the first Forum for the Implementation of Legal Abortion, with participation of the President of the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO). After that, a National Committee on Abortion According to the Law was created within FEBRASGO. Since then, the Committee, in collaboration with CEMICAMP, women’s organizations and other NGOs, has prepared and published norms and assisted public hospitals in the implementation of legal abortion services. This effort was greatly reinforced by a decree of the Ministry of Health, establishing the official “Norms for the care of women and adolescent who suffer sexual violence”, which include safe abortion. The number of public hospitals providing safe legal abortion services has increased steadily since then, reaching about 40, at last count, distributed in all the regions of the country and mostly organized in teaching university hospitals. The process of creating new services will be described in the presentation. More important than the number of women who are assisted is the society’s understanding and progressive acceptance that women need to have access to safe abortion.
SS2.03.04 WOMEN’S ROLES IN MAKING ABORTION SAFER Adrienne Germain, International Women’s Health Coalition 24, NY 10010, USA At the International Conference on Population and Development (ICPD) in Cairo in 1994, the world’s governments recognized that some 80,000 women still die worldwide each year because of unsafe abortion, and hundreds of thousands more suffer long-term illness and injury. The governments agreed to address this major public health issue by ensuring that abortion, where legal, is safe, by providing high quality services for women who suffer complications from unsafe abortion; and by reducing unwanted pregnancy. In 1999, United Nations consultations on progress toward implementing the ICPD governments renewed and extended this commitment. Governments agreed that health system, should train and equip health-service providers and should take other measures to ensure that legal abortion is safe and accessible. The 1994 and 1995 agreements marked a sea change in worldwide recognition of the extent and consequence of unsafe abortion a change generated, in large part, by years of local, national, regional and global organizing by women. This presentation reviews examples of action by women in such countries as Brazil, South Africa, and Poland, and reflects on the challenges ahead to liberalize laws, ensure that services are safe and assessable, and protect against concerted attempts to deny women their reproductive freedom.
FM2.04 HIV IN PREGNANCY m2.04.01 MOTHER TO INFANT TRANSMISSION K. Bharucha, B. .I. Medical College, Pune. Maharashtra,
India
By the end of 1999 USAIDS estimated 33 million people living with HIV AIDS. Almost half of these are women in their reproductive years with one third pregnant. Biological and community norms and economic issues in developing countries aggravate HIV spreading in women. Of these individuals worldwide 63 percent live in sub Saharan Africa and 23 percent in South East Asia. Pediatric AIDS comprises 2 percent in developed and 15-20 percent of all AIDS cases in developing countries. Currently there are one million children living with HIV. 90 percent of them are infected through mother to child transmission. Infant Mortality Rate doubled from 30-60 per 1000 between 1990 to 1996 in Harare, Zimbabwe while the Gambia reported 12 fold increase of infant mortality in uninfected orphans whose parents died of AIDS. Mother to child transmission rates range from 2.5 percent in Europe and USA to 25-40 percent in some African and Asian studies. These have declined to less than 3 percent in USA following intervention with antiretroviral therapy. Perinatal transmission can occur in utero 10 to 15 percent, intrapartum 65 percent and postnatal 7-22 percent due to infant feeding practices. Definition of timing of transmission is based on time of detection of the virus in infant.
There are multiple variable cofactors that facilitate perinatal transmission Viral - load, subtypes, genotypes, resistance, Maternal stage of disease, immunological, nutritional status and presence of coinfection. Obstetrical practices, mode of delivery, prolonged rupture of membranes. Foetalprematurity, genetics, multiple pregnancy order of birth. Infant -feeding practices. Current literature will be presented. Identification of factors that influence transmission is essential for development of effective strategies to prevent perinatal HIV transmission.
m2.04.02 HIV IN PREGNANCY K. University
TREATMENT IN DEVELOPING of Zimbabwe, Harare, Zimbabwe
WORLD
HIV infection is a significant cause of morbidity and mortality. 30.40% of pregnant women are HIV positive. Mother to child transmission is estimated to be 25.50%, in utero in 70%, intrapartum in 19% and post partum in 11%. Use of condom may empower women to protect themselves but there are few interventions for women once infected to prevent progression of disease. Most efforts prevent mother to child transmission (MTCT). Caesarean sections reduce intrapartum infection but may not be practical for developing countries and simple methods such as vaginal douching have had disappointing results. Breast feeding accounts for between 7.22% of MTCT especially during the first 6 months and in the developing world, an alternative is as yet not a feasible proposition. After the results of the ACTG protocol 076, shorter AZT regimen (Thailand) resulted in a 50% reduction if women did not breast feed and in Cote d’Ivoire to 37% if women were allowed to breast feed. Although cheaper than the original 076 protocol the costs for most developing countries is still prohibitive. Nevirapine as a single dose in labor and to new horns during first week of life may reduce transmission by as much as 47% and greatly reduces the cost. Its effect on different Clades needs to be studied. Chloroquin reduces reverse transcriptase activity and has been advocated as a possible alternative. Some data on the effectiveness of the regime will be presented.
FM2.04.03 TREATMENT IN DEVELOPED WORLD M.J. O’Sullivan, University of Miami School of Med, Miami, Florida, United States A summary of the current management of the HIV infected pregnant woman in the United States will be presented. This will include initial workup, if initially diagnosed in pregnancy, as most women are, or evaluation of those entering pregnancy already diagnosed with or without ARV therapy. Drug therapy will be discussed in terms of viral load reduction for mother’s health and reduction of perinatal transmission keeping in mind fetal/neonatal safety of ARV agents. The controversy surrounding the role of cesarean section to prevent perinatal transmission will be discussed. Since many women do not get prenatal care and may not be adequately treated in pregnancy, or not diagnosed until after delivery, the potential role of rapid HIV testing of laboring women and institution of ARV to reduce perinatal transmission in this “last frontier” group will be addressed, as it is in its infancy in the U.S. Finally, adherence issues will be discussed with the aim to increase an understanding of where many women are in their daily existence.
FM2.05 INFECTIONS
IN LATE PREGNANCY
m2.05.01 INFECTION AND PRETERM LABOUR D.Vaitkiene, Department of Obstetrics and Gynecology, of Medicine, Kaunas, Lithuania
Kaunas University
Preterm birth is one of the greatest unsolved problems in modern obstetrics. It has been showed that intraamniotic infection (IAI) from microorganisms found in the lower genital tract is implicated both in the etiology and in the complications of preterm birth. In Lithuania this problem is particularly severe, since the prevalence of genital and particularly sexually transmitted diseases (STDs) is high.
SEPTEMBER
7
5
provide access to legal abortion had had minimal success in Brazil up to 1997, when only three public hospitals provided such services. In November of 1996, the Center for Maternal and Child Research of Campinas (CEMICAMP) organized the first Forum for the Implementation of Legal Abortion, with participation of the President of the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO). After that, a National Committee on Abortion According to the Law was created within FEBRASGO. Since then, the Committee, in collaboration with CEMICAMP, women’s organizations and other NGOs, has prepared and published norms and assisted public hospitals in the implementation of legal abortion services. This effort was greatly reinforced by a decree of the Ministry of Health, establishing the official “Norms for the care of women and adolescent who suffer sexual violence”, which include safe abortion. The number of public hospitals providing safe legal abortion services has increased steadily since then, reaching about 40, at last count, distributed in all the regions of the country and mostly organized in teaching university hospitals. The process of creating new services will be described in the presentation. More important than the number of women who are assisted is the society’s understanding and progressive acceptance that women need to have access to safe abortion.
SS2.03.04 WOMEN’S ROLES IN MAKING ABORTION SAFER Adrienne Germain, International Women’s Health Coalition 24, NY 10010, USA At the International Conference on Population and Development (ICPD) in Cairo in 1994, the world’s governments recognized that some 80,000 women still die worldwide each year because of unsafe abortion, and hundreds of thousands more suffer long-term illness and injury. The governments agreed to address this major public health issue by ensuring that abortion, where legal, is safe, by providing high quality services for women who suffer complications from unsafe abortion; and by reducing unwanted pregnancy. In 1999, United Nations consultations on progress toward implementing the ICPD governments renewed and extended this commitment. Governments agreed that health system, should train and equip health-service providers and should take other measures to ensure that legal abortion is safe and accessible. The 1994 and 1995 agreements marked a sea change in worldwide recognition of the extent and consequence of unsafe abortion a change generated, in large part, by years of local, national, regional and global organizing by women. This presentation reviews examples of action by women in such countries as Brazil, South Africa, and Poland, and reflects on the challenges ahead to liberalize laws, ensure that services are safe and assessable, and protect against concerted attempts to deny women their reproductive freedom.
FM2.04 HIV IN PREGNANCY m2.04.01 MOTHER TO INFANT TRANSMISSION K. Bharucha, B. .I. Medical College, Pune. Maharashtra,
India
By the end of 1999 USAIDS estimated 33 million people living with HIV AIDS. Almost half of these are women in their reproductive years with one third pregnant. Biological and community norms and economic issues in developing countries aggravate HIV spreading in women. Of these individuals worldwide 63 percent live in sub Saharan Africa and 23 percent in South East Asia. Pediatric AIDS comprises 2 percent in developed and 15-20 percent of all AIDS cases in developing countries. Currently there are one million children living with HIV. 90 percent of them are infected through mother to child transmission. Infant Mortality Rate doubled from 30-60 per 1000 between 1990 to 1996 in Harare, Zimbabwe while the Gambia reported 12 fold increase of infant mortality in uninfected orphans whose parents died of AIDS. Mother to child transmission rates range from 2.5 percent in Europe and USA to 25-40 percent in some African and Asian studies. These have declined to less than 3 percent in USA following intervention with antiretroviral therapy. Perinatal transmission can occur in utero 10 to 15 percent, intrapartum 65 percent and postnatal 7-22 percent due to infant feeding practices. Definition of timing of transmission is based on time of detection of the virus in infant.
There are multiple variable cofactors that facilitate perinatal transmission Viral - load, subtypes, genotypes, resistance, Maternal stage of disease, immunological, nutritional status and presence of coinfection. Obstetrical practices, mode of delivery, prolonged rupture of membranes. Foetalprematurity, genetics, multiple pregnancy order of birth. Infant -feeding practices. Current literature will be presented. Identification of factors that influence transmission is essential for development of effective strategies to prevent perinatal HIV transmission.
m2.04.02 HIV IN PREGNANCY K. University
TREATMENT IN DEVELOPING of Zimbabwe, Harare, Zimbabwe
WORLD
HIV infection is a significant cause of morbidity and mortality. 30.40% of pregnant women are HIV positive. Mother to child transmission is estimated to be 25.50%, in utero in 70%, intrapartum in 19% and post partum in 11%. Use of condom may empower women to protect themselves but there are few interventions for women once infected to prevent progression of disease. Most efforts prevent mother to child transmission (MTCT). Caesarean sections reduce intrapartum infection but may not be practical for developing countries and simple methods such as vaginal douching have had disappointing results. Breast feeding accounts for between 7.22% of MTCT especially during the first 6 months and in the developing world, an alternative is as yet not a feasible proposition. After the results of the ACTG protocol 076, shorter AZT regimen (Thailand) resulted in a 50% reduction if women did not breast feed and in Cote d’Ivoire to 37% if women were allowed to breast feed. Although cheaper than the original 076 protocol the costs for most developing countries is still prohibitive. Nevirapine as a single dose in labor and to new horns during first week of life may reduce transmission by as much as 47% and greatly reduces the cost. Its effect on different Clades needs to be studied. Chloroquin reduces reverse transcriptase activity and has been advocated as a possible alternative. Some data on the effectiveness of the regime will be presented.
FM2.04.03 TREATMENT IN DEVELOPED WORLD M.J. O’Sullivan, University of Miami School of Med, Miami, Florida, United States A summary of the current management of the HIV infected pregnant woman in the United States will be presented. This will include initial workup, if initially diagnosed in pregnancy, as most women are, or evaluation of those entering pregnancy already diagnosed with or without ARV therapy. Drug therapy will be discussed in terms of viral load reduction for mother’s health and reduction of perinatal transmission keeping in mind fetal/neonatal safety of ARV agents. The controversy surrounding the role of cesarean section to prevent perinatal transmission will be discussed. Since many women do not get prenatal care and may not be adequately treated in pregnancy, or not diagnosed until after delivery, the potential role of rapid HIV testing of laboring women and institution of ARV to reduce perinatal transmission in this “last frontier” group will be addressed, as it is in its infancy in the U.S. Finally, adherence issues will be discussed with the aim to increase an understanding of where many women are in their daily existence.
FM2.05 INFECTIONS
IN LATE PREGNANCY
m2.05.01 INFECTION AND PRETERM LABOUR D.Vaitkiene, Department of Obstetrics and Gynecology, of Medicine, Kaunas, Lithuania
Kaunas University
Preterm birth is one of the greatest unsolved problems in modern obstetrics. It has been showed that intraamniotic infection (IAI) from microorganisms found in the lower genital tract is implicated both in the etiology and in the complications of preterm birth. In Lithuania this problem is particularly severe, since the prevalence of genital and particularly sexually transmitted diseases (STDs) is high.