Transcript abortion
HIV-INFECTED PREGNANT WOMEN AND ABORTION MISS BY JULAPORN SRINHA 1 Introduction HIV-infected pregnant women Abortion Mother to child transmission Decision to continue or terminate pregnancy in HIV-infected pregnant women The effect after the women decided to continue or terminate pregnancy The appropriate way for these problem in Thailand Conclusion 2 Introduction increase HIV/AIDS in women increase HIV-infected pregnant women increase orphan The women have HIV infected by sexual contact with infected person sharing needles/syringes blood transmission 3 Eg. From one hospital in Bangkok,1996 40 HIV infected mothers 95% got the disease from her husband Eg.Stringer et al,1999 480 Thai physicians: unwilling to perform Pelvic examination(19.2%) Vaginal delivery(30.7%) Cesarean section(39.5%) 4 Abortion One way that HIV-infected were chosen Expulsion of the fetus from the womb during the first 28 weeks of pregnancy Induced abortion 5 Thai Penal Code Section 305 :Abortion is illegal except in 2 cases The first: the health of the mother The second :rape 6 Opinion in some group in abortion Prajayyothin,1996: 727 student 15 to 24 yrs,Bangkok >80% don’t to prefer to abortion method Kamkorn,1997: 704 female vocational student in Bangkok .87.2% > 80% do not agree with abortion Otherwise it might be reasonable for some critical medical condition such as high risk pregnancy or sexual transmitted disease (HIV positive)and so on 7 Mother to child Transmission One-third It is also not clear why some babies of HIV-positive women are infected and other are not Developed countries: 15%-20% Developing countries: 25%-35% 8 Period of Transmission Antenatal(during pregnancy) Perinatal (delivery) Postnatal (breastfeeding) 9 Preventing mother to child transmission of HIV Antiretroviral therapy ACTG 076: AZT ,1996 100 women : 25.5% ($1,701,333) save $1,596,831 8.3% ($104,502) Efficacy of treatment 10 Cesarean section and Antiretroviral treatment 414 women received AZT ,Ricci,2000 10.6% give birth to have infected babies during vaginal delivery 1.7% during cesarean section 11 Breastfeeding Not to breastfeed through breastfeeding Use powder milk But breastfeeding should be recommended HIV infected women in areas where infectious disease and malnutrition are the main cause of infant deaths and where infant mortality is high 12 Decision to continue or terminate pregnancy source No. of HIV+ women No. decided terminate % decide terminate Selwyn et al,1989 Sunderland et al ,1992 Chaiprasitti,1994 Kongsakorn ,1995 Auttagovit,1995 Teanchai,1996 28 32 9 20 154 150 14 6 4 4 38 57 50% 18.8% 44.4% 20% 24.7% 38% 13 Factor that involved in decision Data physician Husband’s perception Economic status Religion Education Status of disease Power within their families Age of pregnancy 14 The effect after the decision Mainly,women who decided to keep the baby faced longer to more serious problems than the one who terminated their pregnancies Economic religion sickness orphans 15 The appropriate way for these problem Preventing infected in women Education in HIV/AIDS Advocate for women in HIV screening test Antiretrovirus ,cesarean section powder milk orphans Supporting group Service system counselor 16 For this problem in Thailand in 1999: 1433,593,500 bahts 72.83% use in servicing ,treatment,and counselling Conclusion The HIV-infected women decided to continue or terminate pregnancy is the complex process The pregnant women’s right to choose to abortion when she have HIV infection 17 This question is too difficult to answer Every one can answer when the world blows out. In some situation ,you cannot decide them to be right or wrong. It depend on her decision because of she is first person to receive the result of effect. Everybody would like to agree with her decision and support her health both body and mental health. We would like to support them in stead to judge them because you are not referee but you are the person in supporting group. 18 19