SKDI 2012
Infeksi pada kehamilan :
hepatitis TORCH, hepatitis, malaria 3B
Hepatitis dalam kehamilan
PENDAHULUAN
Vertically
Mother To Child Transmission
•Transplacental infection •"Ascending infection"
•Microtransfusion •Direct contact by infant
Prenatal 5-10%
Intrapartum 15-20%
Lactation 10-15%
Obstetrik
- Kelahiran per vaginam vs SC
- KPD yang terbengkalai
Maternal - Pendarahan intrapartum (Kala
- Viral load yang tinggi II)
(>10.000 copies/mL) - Chorioamnionitis
- CD4<350/ T limfosit count) - Prosedur invasif (misal epis,
- Infeksi virus, bakteri, parasit EF/EV
- Defisiensi vitamin A
- IDUs Bayi
- Banyak pasangan seksual - Preterm (BBLR) < 34 mg
- ASI/Mastitis
- Luka di mulut bayi
Diagnostik
• VCT
Terapi
ARV sedini mungkin tanpa memandang usia
kehamilan, stadium klinis dan jumlah CD4.
PERSALINAN
• Pervaginam vs perabdominam
• Informed consent
• Syarat pervaginam
- Terapi ARV teratur minimal 6 bulan
dan/atau
- HIV DNA viral load <1000 copies/ml saat
usia kehamilan 36 minggu
• Jika persalinan pervaginam : hindari pemecahan
kulit ketuban, episiotomi, persalinan pervaginam
dengan tindakan
• When replacement feeding is affordable,
feasible, acceptable, sustainable and safe,
avoidance of all breastfeeding is
recommended.
• Where breastfeeding is the only option, this
should be exclusive breastfeeding for 4-6
months
• At 4-6 months, cessation of breastfeeding
should be as rapid as possible
Malaria dalam kehamilan
Facts about Malaria and Pregnancy
• Malaria is more frequent and complicated during
pregnancy
• In malaria-endemic areas, malaria during pregnancy
may account for:
– Up to 15% of maternal anemia
– 8–14% of low birthweight
– 3–8% of infant death
Types of Malaria
• Uncomplicated:
– Most common
• Severe:
– Life-threatening, can affect brain
– Pregnant women more likely to get severe malaria
than non-pregnant women
Maternal complication
In non-Endemic areas
• Greater risk of severe
In Endemic areas disease
• Malaria related anaemia • Higher risk of death
• Febrile illness • Anaemia,
• Placental sequestration hypoglycemia,
pulmonary oedema,
renal failure
Severe malaria
• Cerebral malaria: coma
• Hypoglycemia
• Shivering/chills/rigors
• Confusion/drowsiness/coma
• Headaches • Fast breathing, breathlessness, dyspnea
• Muscle/joint pains • Vomiting every meal/unable to eat