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

Yıl 2020, Cilt: 10 Sayı: 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

Öz

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.

Anahtar Kelimeler

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

Management of HIV Infection during Pregnancy by Gynecologist and Obstetricians

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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