Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi

Year 2020, Volume: 10 Issue: 2, 223 - 227, 31.05.2020

Mustafa Altındiş , Hilal Uslu Yuvacı , Hande Toptan , Tuğba Kaya , Serhan Cevrioğlu , Oğuz Karabay

https://doi.org/10.33631/duzcesbed.664720

Abstract

Amaç: HIV (Human
Immunodeficiency Virus) (+) gebe yönetiminde, tarama testleri ve viral yük
incelemeleri, etkili antiretroviral tedavi, sezaryen ile doğum ve emzirmeden
kaçınma en güncel konulardır. Bu çalışmada kadın hastalıkları ve doğum (KD)
hekimlerinin HIV (+) gebe yönetimi konusundaki bilgi, tutum ve davranışlarının
incelenmesi amaçlanmıştır.

Gereç ve
Yöntemler: Demografik
bilgiler ve literatürden destek alınarak HIV (+) gebe yönetimine yönelik
hazırlanan online/dijital anket ile KD hekimlerine ulaşılarak konu ile alakalı
bilgi, tutum ve davranışları belirlenmeye çalışıldı.

Bulgular: Toplam 125
katılımcının 52’si (%41,6) erkek, 86’sı (%68,8) uzman hekim, 13’ü (%10,4)
araştırma görevlisi, 34’ü (%27,2) 20 yıl ve üzeri mesleki deneyime sahip, 115’i
(%92) gebelerden düzenli olarak Anti-HIV testi istemekte olup 77’sinin (%61,6)
en az bir kez Anti-HIV pozitif gebe hastası olmuş, 49’u (%39,2) bugüne kadar
Anti-HIV pozitif gebe takibi yapmış, 51’i (%40,8) ise Anti-HIV pozitif en az
bir gebeye doğum yaptırmıştı. Hekimlerin 121’i (%96,8) Anti-HIV pozitif
gebeleri doğrulama testlerine yönlendirirken 19’u (%15,2) Anti-HIV pozitif
anneye emzirmemesi konusunda bilgi vermediğini belirtti. Doğum sırasında HIV
RNA düzeyleri >1000 kopya/mL veya viral yükü bilinmeyen Anti-HIV pozitif
gebede IV zidovudin uygulanmasının bebeğe bulaş riskini azalttığını bilenler 79
(%63,2) iken HIV (+) anneden doğana profilaksi amaçlı altı hafta zidovudin
kullananlar 55’tir (%44). Anti-HIV (+) annenin doğum şekli için “Viral yükü
<50 kopya/ml olan gebelerde vajinal doğum yapabilir” diyenler 35 (%28), “Her
halükârda sezaryen” diyenler 43’tür (%34,4). Ante, intra ve postpartum dönemlerde
Antiretroviral tedavi (ART) ile HIV'in virolojik baskılanmasıyla, yenidoğana
perinatal HIV bulaşı %1’lerin altına düşebilir diyenler 47’dir (%37,6).

Sonuç: KD hekimlerine,
emzirmeme konusu başta olmak üzere tarama testleri/proflaksi konusu hatırlatılmalı
ve eğitimlerin düzenliliği sağlanmalıdır.

Keywords

Gebelik, fetal takip, HIV antikorları, bilgi, tutum, tıbbi uygulama yönetimi

Management of HIV Infection during Pregnancy by Gynecologist and Obstetricians

Abstract

Aim: In this study,
it was aimed to investigate the knowledge, attitudes and behaviors of
gynecologists and obstetricians (G/O) during pregnant management in terms of
HIV.

Material and Methods: Online questionnaire was reached to G/O physicians to determine relevant
knowledge about HIV (+) pregnant management. Information was evaluated by MS
Excel.

Results: Of the
total 125 participants, 52 (41.6%) were male, 86 (68.8%) were specialist
physicians, 13 (10.4%) were research assistants, 34 (27.2%) had 20 years or
more professional experience, 115 (92%) of the pregnant women regularly ask for
anti-HIV tests, 77 (61.6%) of them had anti-HIV positive pregnant patients at
least once, 49 (39.2%) have followed anti-HIV positive pregnant women so far,
51 (40.8%) had given birth to at least one anti-HIV positive pregnant woman. 19
(15.2%) of the physicians didn’t give information to HIV positive mothers not
to breastfeed. 79 (63.2%) of those who know that IV zidovudine administration
in an HIV positive pregnant with HIVRNA levels> 1000 copies/mL and 55 (44%)
of those who use zidovudine for six weeks for prophylaxis. For HIV(+) maternal delivery type, 35 (28%) of those who stated that
cesarean section had no advantage in terms of transmission in the pregnant with
a viral load <50 copies/ml, and 43 (34.4%) of G/O said that in any case,
cesarean section was performed. 47 (37.6%) of physicians said, "If suppression of HIV occurs
with ART, the perinatal HIV transmission rate to the newborn may fall below
1%."

Conclusion: Screening tests/prophylaxis especially breastfeeding should be reminded
again to O/G physicians and the regularity of these trainings should be
ensured.

Keywords

Pregnancy, fetal monitoring, HIV antibodies, knowledge, attitude, medical practice management

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