Phuapradit W
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Aust N Z J Obstet Gynaecol. 1998 Aug;38(3):293-7. doi: 10.1111/j.1479-828x.1998.tb03069.x.
There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first trimester. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Caesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.
有充分证据表明，与妊娠早期相比，妊娠晚期和分娩期间HIV-1垂直传播率更高。在妊娠晚期和分娩期间给予母亲单一或联合抗逆转录病毒疗法可降低母体循环中的病毒载量。通过适当的分娩时机和途径可将分娩期间的HIV-1垂直传播降至最低。与其他分娩方式相比，在临产前进行择期剖宫产且胎膜完整，母婴间的微量输血最少。由于目前尚未确定类似于乙肝病毒模型的、给予暴露于HIV-1的新生儿有效的HIV-1免疫球蛋白和HIV-1疫苗联合预防HIV-1传播的方法，因此对于HIV-1感染母亲所生婴儿，提倡暴露后抗逆转录病毒预防和不进行母乳喂养。对于母亲HIV-1感染处于晚期以及营养不良普遍存在的发展中地区的情况，建议提供充足的必需微量营养素作为减少HIV-1围产期传播的辅助措施。
