Masters Degrees (Obstetrics and Gynaecology)

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Browsing Masters Degrees (Obstetrics and Gynaecology) by Subject "AIDS (Disease) -- Transmission"

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    A descriptive study of patients at high risk for mother-to-child transmission (MTCT) of HIV at Tygerberg Hospital: a retrospective review
    (Stellenbosch : Stellenbosch University, 2016-12) Parker, Liaquat Ali; Theron, Gerhardus Barnard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: AIM This is a sub study of a main study with the primary aim of early identification of infants at high risk for HIV transmission, starting them on ARVs to prevent seroconversion and also possibly reverse early seroconversion. A secondary aim of the main study and our main focus is to identify the characteristics of mothers who are at a high risk of transmitting their HIV infection to their infants in the antepartum and intrapartum period. METHODS This was a retrospective study conducted at Tygerberg Hospital (TBH). A review of files spanning a 21 month period from the period 1 January 2011 till 30 September 2012 was performed. The selection criteria included pregnant HIV patients who were: exposed to AZT monotherapy for PMTCT for 4 weeks or less, exposed to combination ART for 4 weeks or less without preceding AZT monotherapy, with a measured plasma HIV viral load of ≥1000 copies/ml ≤8 weeks before birth, defaulted ART during pregnancy, first presented as HIV-seropositive at delivery or early in the postpartum period and delivered before 37 weeks gestational age. RESULTS During the study period a total number of 301 patients and their children were included in the study. These patients all came from a low to middle income resource setting. The mean age at delivery was 26.9 years. The median gravidity and parity was 3 and 1 respectively. The median gestational age at initiating antenatal care was 26 weeks. The mean gestational age at booking was 24.8 weeks. 35 patients were on ARVs during pregnancy. Of the remaining 266 patients: 143 patients were started on AZT prophylaxis during pregnancy, and 123 patients were never initiated on AZT prophylaxis. The mean gestation of AZT initiation was 27 weeks. A total of 108 patients never initiated any antenatal care at all. A total of 7 patients presented with antepartum haemorrhage and 21 mothers were grouped as having infections during pregnancy. The total number of deliveries was 301. 49.5% of all the deliveries were normal vertex deliveries. A total of 187 patients received AZT in labour. 115 patients received no AZT prophylaxis at all. More than half of the patients (188) in the study were seen with either medical complications or pregnancy related complications. 114 patients (37.8%) had hypertensive disease in pregnancy. 224 patients (74%) were diagnosed with HIV during the index pregnancy and 3.1% were diagnosed with HIV during labour. CONCLUSION It is clear that patients who do not initiate antenatal care have an increased risk of transmission in a population with an increased prevalence of HIV disease. Additional factors are the lack of initiation of ARV drugs at antenatal clinics and preterm labour and preterm deliveries.