Phuapradit W, Chaturachinda K, Saropala N, Chittacharoen A, Sirinavin S, Kunakorn M
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Aust N Z J Obstet Gynaecol. 1995 May;35(2):168-72. doi: 10.1111/j.1479-828x.1995.tb01861.x.
The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for AZT administration to the seroconverted pregnant women for reduction of perinatal transmission. 4. There should be available the appropriate back up services for seropositive pregnant women such as: (i) C--Choice. Having been appropriately counselled the pregnant women should be able to terminate or continue with the pregnancy. (ii) H--High-risk pregnancy concept. The pregnant women should be treated as high-risk cases. Throughout their pregnancy and delivery only experienced personnel should manage them. (iii) I--Integrated services. From our experience it would be reasonable to integrate the care of seropositive pregnant women with any other high-risk cases. Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.
基于本研究，提出以下建议。1. 对所有孕妇进行常规HIV感染自愿筛查是可行且有价值的。2. 在得出明确结论前，每个血清学阳性结果都应重复检测以确认，避免误诊。3. 血清学阴性的孕妇在孕晚期应再次进行常规筛查，以检测血清转化情况，因为这为血清转化的孕妇提供了服用齐多夫定以降低围产期传播的机会。4. 应为血清学阳性的孕妇提供适当的后续支持服务，例如：(i) C——选择。在得到适当咨询后，孕妇应能够决定终止或继续妊娠。(ii) H——高危妊娠概念。孕妇应被视为高危病例。在整个孕期和分娩过程中，应由经验丰富的人员进行管理。(iii) I——综合服务。根据我们的经验，将血清学阳性孕妇的护理与其他高危病例的护理整合是合理的。开设专门的或匿名的诊所可能会让女性产生不安情绪，使她们感到被疏远和歧视。(iv) P——提供护理。必须提供全面的服务。这些服务包括经验丰富的咨询团队、充足的实验室服务、安全的孕早期和孕中期治疗性流产服务、为感染病例在产房提供适当的设施（包括剖宫产），以及专业的儿科医生。
