Special aspects of gestation course, prenatal care and labor management in HIV positive women (literature review)
The article presents brief historical aspects of HIV infection and the ways of the placental penetration of the infection. It also describes the most important routes of HIV transmission from mother to fetus. The main source of the infection is a contact of baby with the maternal blood during delivery (50 %) and breastfeeding during the postnatal period (33-50 %). The fetus infection often occurs during the 3rd trimester of pregnancy. The main causes of such infection are infected amniotic fluid influence on the fetus mucous membranes and trans-placental viral micro-transfusion. The factors to increase the risks of infections are given. They are high viral load, lack of antiretroviral treatment during pregnancy and concomitant infections. Premature rupture of membranes increases the infection considerably (by 2 % each hour of delivery interval). The article highlights the risks of infection during a multifetal pregnancy. There is a relation between the placenta (the placental alkaline phosphatase) function change and the risks of intrauterine infection. The article presents the information on the risks of fetus infection during the intranatal period and newborn baby infection during the early and late neonatal periods. The literature data on the HIV-pregnancy complication frequency is also provided in the article. The most frequent pregnancy complications are: miscarriage and preterm delivery, premature rapture of membranes, delivery of a low-birth-weight and low-Apgar-score infant. The article provides the data on a considerable reduction of vertical HIV transmission in the course of ART based on literature analysis. The work gives an account of the additional factors such as smoking, alcohol and drug abuse, anemia and chronic inflammatory processes and infections. There are modern views on the management of cases of premature rupture of membranes at the onset of labour. The preferable way of childbirth is a scheduled cesarean delivery. The article points at the drastic increase of infection complications of HIV-positive women during the post-natal period.