Disease transmission, vertical Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2008;30(3):135-141
DOI 10.1590/S0100-72032008005000003
PURPOSE: to evaluate the attitudes and knowledge of obstetricians from public maternities in Salvador city (PMS) about the recommendations from the Health Ministry (HM) for the prophylaxis of vertical transmission of HIV (VTH) and antiretroviral therapy in pregnant women. The influence of working conditions, availability for quick testing and antiretroviral therapy has also been evaluated concerning the application of these recommendations. METHODOLOGY: a transversal study from August to November 2005, involving 129/152 (85%) of the obstetricians from all the PMS. The instrument used was a structured and self-explanatory anonymous questionnaire, with questions on the population characteristics, working conditions and availability of material, knowledge and attitudes related to HIV counseling and testing, and proceedings with the patients (use of AZT, recognition of risk factors, choice and management of type of delivery and puerperal care). RESULTS: 69% of the obstetricians stated they knew integrally the HM recommendations, 90.7% agreed with the compulsory request of quick testing for HIV; 63.6% chose the caesarean section as the type of delivery; 38% were against normal delivery; 37.5% recommended isolation of positive serum patients and 58.1% indicated tubal ligation. Most of them (90%) mentioned the existence of factors unfavorable to the recommendations applicability, and among those factors, the most pointed were the inadequate way the pre-natal admission was done and the lack of information at that occasion. Even though the quick testing was available, only one third of the interviewees stated that the result was always available in due time. CONCLUSIONS: some attitudes related to the assistance to the pregnant women with HIV were incompatible with the HM recommendations. According to the interviewees, the inadequacy of the pre-natal plus the non-availability of quick testing, influence negatively the applicability of VTH prophylaxis recommendations.
Summary
Rev Bras Ginecol Obstet. 2008;30(3):135-141
DOI 10.1590/S0100-72032008005000003
PURPOSE: to evaluate the attitudes and knowledge of obstetricians from public maternities in Salvador city (PMS) about the recommendations from the Health Ministry (HM) for the prophylaxis of vertical transmission of HIV (VTH) and antiretroviral therapy in pregnant women. The influence of working conditions, availability for quick testing and antiretroviral therapy has also been evaluated concerning the application of these recommendations. METHODOLOGY: a transversal study from August to November 2005, involving 129/152 (85%) of the obstetricians from all the PMS. The instrument used was a structured and self-explanatory anonymous questionnaire, with questions on the population characteristics, working conditions and availability of material, knowledge and attitudes related to HIV counseling and testing, and proceedings with the patients (use of AZT, recognition of risk factors, choice and management of type of delivery and puerperal care). RESULTS: 69% of the obstetricians stated they knew integrally the HM recommendations, 90.7% agreed with the compulsory request of quick testing for HIV; 63.6% chose the caesarean section as the type of delivery; 38% were against normal delivery; 37.5% recommended isolation of positive serum patients and 58.1% indicated tubal ligation. Most of them (90%) mentioned the existence of factors unfavorable to the recommendations applicability, and among those factors, the most pointed were the inadequate way the pre-natal admission was done and the lack of information at that occasion. Even though the quick testing was available, only one third of the interviewees stated that the result was always available in due time. CONCLUSIONS: some attitudes related to the assistance to the pregnant women with HIV were incompatible with the HM recommendations. According to the interviewees, the inadequacy of the pre-natal plus the non-availability of quick testing, influence negatively the applicability of VTH prophylaxis recommendations.
Summary
Rev Bras Ginecol Obstet. 2006;28(3):184-189
DOI 10.1590/S0100-72032006000300008
PURPOSE: to evaluate the chronic effects of nelfinavir on body weight gain of pregnant albino rats and their concepts, as well as on the number of implantations, reabsorptions, fetuses, placentae, and maternal and fetal mortality. METHODS: fifty pregnant EPM-1 Wistar albino rats were randomly divided into five groups: two controls, Contr1 (control of stress) and Contr2 (drug vehicle control), and 3 experimental groups, Exp40, Exp120, Exp360, which received 40, 120 or 360 mg/kg per day of oral solution of nelfinavir, respectively. The drug and the vehicle (distilled water) were administered twice a day (12/12 h) by gavage from the first up to the 20th day of pregnancy. After sacrifice under deep anesthesia, the following parameters were evaluated: number of implantations and reabsorptions, the weight of fetuses and placentae, and the number of intrauterine deaths as well as inspection for major malformations. Data were evaluated by ANOVA followed by the Kruskal-Wallis multiple comparison test. RESULTS: body weight gain during pregnancy was normal for all the groups, and no significant differences were detected between them. ANOVA did not reveal any significant effect of nelfinavir on the studied parameters. The means of number of fetuses were: control = 9.7±0.50; nelfinavir-treated groups = 9.7±0.81. Regarding the means of number of placentae and implantations, controls = 9.7±0.50; nelfinavir-treated groups = 9.6±0.78. The mean fetal weights were as follows: controls = 4.04±0.50; nelfinavir-treated groups = 3.91±0.33 g. Finally, control placental weights averaged 0.64±0.02; nelfinavir-treated groups = 0.67±0.02 g. CONCLUSION: nelfinavir was well tolerated at all the administered doses; no damage was produced on the fetuses.
Summary
Rev Bras Ginecol Obstet. 2006;28(3):184-189
DOI 10.1590/S0100-72032006000300008
PURPOSE: to evaluate the chronic effects of nelfinavir on body weight gain of pregnant albino rats and their concepts, as well as on the number of implantations, reabsorptions, fetuses, placentae, and maternal and fetal mortality. METHODS: fifty pregnant EPM-1 Wistar albino rats were randomly divided into five groups: two controls, Contr1 (control of stress) and Contr2 (drug vehicle control), and 3 experimental groups, Exp40, Exp120, Exp360, which received 40, 120 or 360 mg/kg per day of oral solution of nelfinavir, respectively. The drug and the vehicle (distilled water) were administered twice a day (12/12 h) by gavage from the first up to the 20th day of pregnancy. After sacrifice under deep anesthesia, the following parameters were evaluated: number of implantations and reabsorptions, the weight of fetuses and placentae, and the number of intrauterine deaths as well as inspection for major malformations. Data were evaluated by ANOVA followed by the Kruskal-Wallis multiple comparison test. RESULTS: body weight gain during pregnancy was normal for all the groups, and no significant differences were detected between them. ANOVA did not reveal any significant effect of nelfinavir on the studied parameters. The means of number of fetuses were: control = 9.7±0.50; nelfinavir-treated groups = 9.7±0.81. Regarding the means of number of placentae and implantations, controls = 9.7±0.50; nelfinavir-treated groups = 9.6±0.78. The mean fetal weights were as follows: controls = 4.04±0.50; nelfinavir-treated groups = 3.91±0.33 g. Finally, control placental weights averaged 0.64±0.02; nelfinavir-treated groups = 0.67±0.02 g. CONCLUSION: nelfinavir was well tolerated at all the administered doses; no damage was produced on the fetuses.
Summary
Rev Bras Ginecol Obstet. 2005;27(11):683-690
DOI 10.1590/S0100-72032005001100009
PURPOSE: to evaluate human immunodeficiency virus (HIV) vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p<0.05). RESULTS: HIV infection was confirmed in 84 (45.4%) patients during gestation. Viral load was below 1,000 copies/mL in 60.4% patients. Highly active antiretroviral therapy was the predominant antiretroviral regimen (65.5%). C-section rate was high: 79.5%. Prematurity rate was 18.2%. There were 184 (97.8%) live births and four (2.2%) perinatal deaths among 188 neonates. Among live neonates 97.8% received zidovudine after birth. Global mother-to-child transmission rate was 3.8%. Virus vertical transmission rates for each period were: 60%, until 1996; 28% between 1996 and 1998; 0.68%, between 1999 and 2004. Significant risk factors were not found related to perinatal HIV-infection because there was a small number of infected neonates (n=6). CONCLUSION: there was a great reduction of HIV vertical transmission during the analyzed period. Current transmission rate is zero. This confirms that by adopting adequate measures perinatal virus transmission can be prevented.
Summary
Rev Bras Ginecol Obstet. 2005;27(11):683-690
DOI 10.1590/S0100-72032005001100009
PURPOSE: to evaluate human immunodeficiency virus (HIV) vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p<0.05). RESULTS: HIV infection was confirmed in 84 (45.4%) patients during gestation. Viral load was below 1,000 copies/mL in 60.4% patients. Highly active antiretroviral therapy was the predominant antiretroviral regimen (65.5%). C-section rate was high: 79.5%. Prematurity rate was 18.2%. There were 184 (97.8%) live births and four (2.2%) perinatal deaths among 188 neonates. Among live neonates 97.8% received zidovudine after birth. Global mother-to-child transmission rate was 3.8%. Virus vertical transmission rates for each period were: 60%, until 1996; 28% between 1996 and 1998; 0.68%, between 1999 and 2004. Significant risk factors were not found related to perinatal HIV-infection because there was a small number of infected neonates (n=6). CONCLUSION: there was a great reduction of HIV vertical transmission during the analyzed period. Current transmission rate is zero. This confirms that by adopting adequate measures perinatal virus transmission can be prevented.
