|
王临虹：预防艾滋病、梅毒母婴传播进展
www.xtata.com发表时间：2011-09-23来源：腾讯
妇女梅毒和艾滋病病毒(HIV)感染，在妊娠期均可通过母婴传播造成不良的妊娠结局。在第四届中华妇幼健康大会上，中国疾病预防控制中心妇幼保健中心副主任王临虹介绍了预防艾滋病、梅毒母婴传播的进展，为开展孕产期联合预防HIV感染和梅毒传播综合服务提供参考。
妊娠梅毒对HIV母婴传播的影响
王教授介绍说：“与一般人群相同的协同作用机理，妇女在妊娠期也可出现HIV与梅毒联合感染，一些研究显示，8%-11%的孕妇发生联合感染。HIV感染的妇女，且离婚、独居、寡居更容易感染梅毒。20-24岁的女性梅毒的发生率最高，性伴的个数与梅毒感染相关。”
孕期梅毒和HIV联合感染可能会通过附加或联合作用，增加不良妊娠结局的发生。例如，梅毒感染可以造成胎盘病理学改变，如慢性炎性改变、绒毛萎缩和局灶性坏死等，破坏了母胎循环的血管内皮细胞，因而影响胎儿的生长发育，以及增加了HIV的母婴传播。同时由于梅毒增加了早产发生，也增加了HIV的母婴传播几率。
孕产妇应寻求相关检测咨询服务
各级医疗卫生机构均应结合孕产期保健和助产服务开展检测咨询服务，主动为所有孕妇提供检测与咨询服务，在孕产妇初次接受产期保健时，同时提供艾滋病、梅毒和乙肝的相关检测，尽早明确感染状况，尽早提供干预措施。
妇女接受抗病毒治疗时应避免妊娠
王教授说，如果是正处在抗病毒治疗的妇女在妊娠时要注意，尽量将提供适宜、有效的避孕方法作为抗病毒治疗中的一部分，以避免非意愿妊娠，同时要注意，抗病毒药物与激素类避孕方法之间存在潜在的相互作用，抗病毒治疗可能降低避孕效率。
及早发现妊娠梅毒
孕产妇梅毒可发生母婴传播、导致自然流产、死产等不良妊娠结局。有研究表明，50%的未经治疗的梅毒的急性期可以导致不良妊娠结局。所以一定要及早发现梅毒，所有婚前、孕前保健和孕前检查的妇女要进行梅毒预防知识的咨询和梅毒检测，对于梅毒感染妇女应动员其性伴/配偶进行检测。
对于已经怀孕的妇女，在每次产前检查均应对孕产妇及其性伴进行危险行为评估，促进其改变高危行为，强调孕期使用安全套，进行安全性行为，避免孕期感染梅毒的重要性。所有(本次或曾经)发生不良妊娠结局，如晚期流产、死胎、分娩过梅毒样儿等的孕妇要进行梅毒检测。还有所有患有性传播感染和确认HIV感染的孕妇要进行梅毒检测，并动员其性伴侣进行检测。
我国目前的母婴传播防治策略
从453个县(市)已经扩展到1156个县(市)，现将母婴传播工作整合到现有的妇幼保健和生殖保健服务中去，将医疗机构主动检测和筛查(PITC)服务应用在孕产妇的筛查中。
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
 |
| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
| |
|
|
WANG Lin Hong: AIDS prevention, mother to child transmission of syphilis progress
www.xtata.com Posted :2011 -09-23 Source: Tencent
Women, syphilis and AIDS virus (HIV) infection, through mother to child transmission during pregnancy can cause adverse pregnancy outcomes. Maternal and child health at the Fourth Conference of China, the Chinese Center for Disease Control Maternal and Child Health Center Director Wang Linhong introduced to prevent AIDS, the progress of mother to child transmission of syphilis, to conduct joint prevention of maternal transmission of HIV infection and syphilis to provide integrated services for reference.
Mother to child transmission of syphilis in pregnancy, the impact of HIV
Prof Wang said: "The collaboration with the general population the same mechanism of action, women can also occur during pregnancy and syphilis co-infected with HIV, some studies show that 8% -11% of pregnant women co-infected. HIV-infected women, and divorce , single, widowed more susceptible to syphilis. women aged 20-24 the highest incidence of syphilis, the number of sexual partners associated with syphilis infection. "
Syphilis and HIV co-infection during pregnancy may be attached or by the combined effects of increased incidence of adverse pregnancy outcomes. For example, syphilis can cause pathological changes in the placenta, such as chronic inflammatory changes, villous atrophy and focal necrosis, destruction of the maternal-fetal circulation of the vascular endothelial cells, thus affecting fetal growth and development, and increased mother to child transmission of HIV . And because syphilis increased preterm birth, also increased the risk of mother to child transmission of HIV.
Pregnant women should seek testing and counseling services related to
Medical and health institutions at all levels should be combined with maternal health and midwifery services to carry out testing and counseling services, testing for all pregnant women take the initiative and consulting services, product acceptance in the initial period of maternal care, while providing AIDS, syphilis and hepatitis B-related detection, clear infection as soon as possible, provide early intervention.
Women receiving antiretroviral treatment should avoid pregnancy
Professor Wang said that if anti-viral therapy is in pregnancy, women should pay attention, try to provide appropriate and effective contraceptive methods as part of antiretroviral therapy in order to avoid an unwanted pregnancy, keeping in mind, antiviral drugs and hormonal method of contraception there is a potential interaction between the anti-viral treatment may reduce the contraceptive effectiveness.
Early detection of syphilis in pregnancy
Maternal child transmission of syphilis can occur, leading to spontaneous abortion, stillbirth and other adverse pregnancy outcomes. Studies have shown that 50% of untreated syphilis can cause acute adverse pregnancy outcomes. They must be detected early syphilis, all pre-marital, pre-pregnancy care and pre-pregnancy check women for syphilis prevention knowledge to counseling and syphilis, syphilis infection in women for their sexual partners should be mobilized / spouse for testing.
For already pregnant women, prenatal care should be for every pregnant women and their sexual partners, risk behavior assessment, to promote their high-risk behavior change, emphasizing the use of condoms during pregnancy, safe sex, the importance of avoiding syphilis infection during pregnancy. All (or have the time) of adverse pregnancy outcomes, such as late miscarriage, stillbirth, delivery of pregnant women had syphilis gentile, etc. to conduct syphilis testing. There are all suffering from sexually transmitted infections and HIV-infected pregnant women to confirm syphilis testing, and to mobilize their sexual partners for testing.
China's current strategy of mother to child transmission prevention
From 453 counties (cities) has been extended to 1156 counties (cities), now mother to child transmission of work into existing maternal and child health and reproductive health services to, the medical institutions active detection and screening (PITC) service applications in maternal screening.
|
