OVERVIEW OF PREVENTION OF MOTHER TO CHILD

TRANSMISSION (PMTCT) IN UNIVERSITY OF PORT

HARCOURT TEACHING HOSPITAL.
GOAL OF PMTCT

To generate information for the formulation of national policy and a

comprehensive PMTCT intervention in Nigeria.

To critically appraise and reduce MTCT of HIV in Nigeria.

Identification and Support of HIV infected pregnant women

and their families – access to care.

Anti retroviral therapy strategy to reduce maternal viral load and

subsequent reduction in the fetus.

Modification of obstetric practices.

Modification of breast feeding practices

.
Continuity of care for infected women and their families, proper
follow up for infant.
 FACTS ON MTCT
10-30% During Pregnancy,
1.3 Million Children living with HIV/AIDS worldwide.
-40-60% Delivery
-15-20% Breastfeeding
Generally MTCT rates are 15-20% in developed countries (BMS) and
39-45% in developing countries (Mixed Feeding Transmission rates
globally in absence of ARV 14 – 40% with ARV 2-15%
PREVENTION STRATEGIES

Obstetric Factors
 Duration of membrane rupture >4 hours related to doubling risk
of MTCT.
 Elective caesarean section in meta-analysis and randomized
trial associated with 50% reduction in MTCT (French study).
 Beckermann’s group in California in 2002 queried the place of
routine use of Elective Caesarean Section since risk of MTCT
was reduced in women on anti-retroviral therapy with
undetectable viral load in 80 patient with vaginal delivery only 3
had MTCT.
 Chorioamnionitis – is associated with increase risk in some
studies (Zaire, PACTG 185, Ariel Project)
 Obstetric Factors Contd.

 Increased HIV in cervico-vaginal secretion during pregnancy.

 Thus increase Transmission in Labour.
 Genital Tract infection
 Obstetric Haemorrhage.
 Intrapartum
 Invasive Obstetric Procedure
 Chorionic Villous Biopsies
 Fetal Scalp Electrodes
 Instrumental Deliveries of which forceps is at a lower risk than
vacuum.
 Episiotomy and vaginal tears.
 FETAL FACTORS
 Prematurity
 Multiple pregnancies especially in Twin I in Vaginal Delivery
 Fetal nutrition
 Fetal immune status
 Genetic factors such as maternal and infant HLA Human
Leucocytes antigen Concordance
 Low birth weight
 INFANT FACTORS
Breastfeeding; Accounts for 15-40% Ver.
Trans. Rate in absence of ARV. As
against 18% for formula feed babies
Mixed feeding
Breast abscess
Mastitis
Active nipple disease
Paediatric thrush
 ANC: CARE
Health Education
VCT – Pre Test, Post test
Rapid test; Abbot determine, Unigold, Immunocomb (confirmatory)
Full Blood Count.
LAB; CD4 count, Hepatitis B and C
Avoid invasive diagnostic procedures
Watch for Tell Tale Signs –TB
Family/Nutritional Support.
Treat Malaria/ARV/Opportunistic infection
Fe/FA supplement
Family Planning
 CARE IN LABOUR &
DELIVERY
Avoid ARM / PROM / FETAL SCALP PROCEDURES.
Universal Precaution is applied
Avoid Routine Episiotomy
Forceps Preferable to Vacuum
Elective C/S at 38 weeks- Beneficial
Prophylactic antibiotics
POST PARTUM CARE
 No Separate Nursing Facilities
 Avoid Stigma
 Watch for infection
 Care of perineum
 Safe handling of Lochia, Sanitary Material
CARE OF NEONATES
Handle babies with gloves until secretions and Blood are
washed off.
Infant feeding decision breast feeding approximately doubles
the risk of HIV from 15 to 30% but avoidance of breastfeeding
significantly reduces rates of infection (Kreiss) 1997.
Mixed feeding is strongly discouraged.
Expressing and heat treating of breast milk (62.5C for 5
minutes) Pretorian Regime.
Breast Milk from another woman (Such as HIV negative wet
nursing or banked milk).
Syrup Nevirapine 2mg/kg start dose within 72 hours of birth.
Children born to HIV positive women should be followed up on
regular basis.
 ANTI RETROVIRAL
TREATMENT REGIMEN IN
PREGNANCY AND LABOUR
ARV ANTENATAL INTRAPARTUM POSTPARTUM
NEVIRAPINE NIL I dose of 200mg 1 dose of
(PMTCT) orally at onset of 2mg/kg within
labour 72 hours of
birth.

LAMUVIDINE From 14 weeks

150mg b.d
ZIDOVUDINE
300mg b.d
1 dose of
NEVIRAPINE 2mg/kg within
200mg b.d 72 hours of
birth.
 IMMUNIZATION

BCG & OPV 0 – at birth

DPT – 6 weeks, 10 weeks, 14 weeks

OPV 1,2 and 3. – 6 week, 10 weeks, 14 weeks

Measles - 9 months to 15 months

Hepatitis B Vaccine - At birth, 6 weeks and 6 months

Yellow fever, cerebrospinal-meningitis - 1 year

ALL LIVE VACCINES SHOULD BE AVOIDED AS MUCH AS POSSIBLE

Opportunistic infections - Co-trimoxazole.
 CONCLUSION
PMTCT is an affordable and sustainable
intervention that will drastically reduce
new HIV infections in the general
population and at the same time prolong
and improve the quality of life for those
women already infected.