Mustafa ALTINDİŞ, Hilal USLU YUVACI, Hande TOPTAN, Tuğba KAYA, Serhan CEVRİOĞLU, Oğuz KARABAY

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

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

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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