妊娠合并人类免疫缺陷病毒孕妇围生期管理模式的探讨

To study the management model for pregnant women with human immunodeficiency virus infection in their perinatal period

目的通过对妊娠合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)孕妇围生期综合性干预,探索有效阻断HIV母婴传播的模式。方法选择1999年7月至2006年12月广州市妇婴医院收治的67例妊娠合并HIV孕妇为研究对象。通过孕期医学咨询及同伴教育后,33例孕妇选择终止妊娠(口服米非司酮+米索前列醇);34例孕妇选择继续妊娠(4例为临产入院),对其进行孕期保健、同伴教育、服用抗逆转录病毒药物、择期剖宫产及产后新生儿人工喂养等综合干预。结果33例选择终止妊娠的孕妇中,早孕23例和中孕8例孕妇,口服药物后,全部完全性流产;另外2例采取羊膜腔内注射依沙吖啶(雷佛奴尔)引产,因胎膜残留,行清宫术。34例选择继续妊娠的孕妇中,除临产入院的4例外,其余30例全程接受干预处理,CD4+水平明显上升,CD4+/CD8+上升,Hb水平无明显下降,HIV-RNAcopy明显下降。30例全程接受干预所产新生儿18个月进行第2次HIV IgG检测(2例尚未到时间)时,27例呈阴性,1例呈阳性。4例临产入院所产新生儿,2例HIV IgG呈阳性,1例呈阴性,1例失访。结论妊娠合并HIV孕妇,在围生期有效的干预措施下,不但能对HIV孕产妇进行有效管理,失访率低,而且能有效阻断HIV母婴垂直传播。

Objective To study the effective model for the prevention of mother-to-infant transmission of HIV. Methods 67 pregnant women with human immunodeficiency virus（HIV） infection （July 1999 to December 2006 in Guangzhou Maternal and Infant Hospital） were enrolled in this programme. After counseling and companion education, 33 women elected to terminate the pregnancy, and 34 women elected to continue the pregnancy. All patients were treated appropriately. Results 31 cases were completely aborted with mifepristone plus misoprostol. 2 cases were aborted with invasive rivanol plus surgical curettage. 34 cases who elected to continue the pregnancy, among 30,whoes levels of CD4^＋ and the ratio of CD4^＋/CD8^＋ were raised, the level of hemoglobin was in the＇normal range, and copies of HIV-RNA were reduced sharply. 28 neonates whose age were at 18 months were detected for HIV-IgG, negative for IgG was found in 27, and positive in 1. 4 neonates whose mothers admitted to the hospital just before labor, 2 neonates were detected to be positive for IgG, 1 neonate negative and 1 lost to follow up. Conclusion Under the preventive measures and intervention for HIV pregnant women of childbearing age, the HIV vertical transmission from mother to-infants can be prevented effectivly.