Re: LNJP Successfully Conduct Cesarean Operation on a+ve mother

[Guest guest]

Re: /message/7849

New Delhi, LNJP Successfully Conduct Cesarean Operation on a+ve mother

Dear FORUM,

Re: LNJP Successfully Conduct Cesarean Operation on a +ve mother. I am not

amused-this is no news I am getting CS done in Amritsar thru PP's and even Govt

Medical college people have done quite a few CS on HIV positive women and that

too for last many years.

Rakesh Bharti MD,AAHIVS,

BDC Research center,

27-D,Sant Avenue,The Mall,Amritsar.

Punjab,INDIA143001.

TEl-91-183-2277822;91-183-2278522

e-mail: <rakesh.bharti1@...

______________________________

Dear FORUM,

It is very heartening to receive a 'positive' news after a long gap when the

reports are full of Meerut and such similar incidents.

We should ,however, appreciate that there is no dearth of such well meaning

doctors in other centres/places also who believe in and practise due infection

control measures and universal safety precautions and are rationally performing

the procedures/surgeries in a confident manner.

Congratulations to all involved .Hope such desirable courses of action become a

regular practice rather than an exceptional activity at all places soon. Best

wishes,

Dr. Rajesh Gopal, MD

Joint Director,

Gujarat State AIDS Control Society (GSACS),

O/1 Block, New Mental Hospital Complex,

Meghaninagar, Ahmedabad, Gujarat. PIN 380016

Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

_________________

Dear FORUM,

We read with interest this news.

I dont know if this was for the first time that this heppened in Delhi. If so

deserves congratulations as well as brickbats. In Pune normal deliveries as well

as Cesarian sections (CS) have been conducted for more than 10 yrs now without

any celebrations like this. But the news also raises a few questions?

1. Why did the ART centre doctor prescribe this regimen for prevention of MTCT?

If she was to be put on ART then (why again) this regimen was selected? This is

definitely not the one recommended at ART centres!

2. Why did DNP+ request for Cesarian operartion? If the woman had taken ARVs for

sufficient duration then advantage of CS are marginal was the decision an

informed one or what? If not much indicated then conducting a CS because someone

requested does not make the best medical sense.

Shall we debate this?

PRAYAS

E-MAIL: <prayashealth@...>

[Guest guest]

Dear FORUM,

Re: /message/7854

Thanks for your observation and comments from Prayas. This certainly is not the

first time cesarian section delivery in Delhi. The whole idea of putting up this

e-forum is that we DNP+ felt that sometimes we need to praise govt. hospital

also for their good work, not just exposing their inefficacy.

We hardly acknowledge the govt. hospital worker but on daily basis DNP+ has

lobbied for the community of PLHIV who are denied treatment for whatever reason.

We just want to ensure that PLHIV gets the best treatment possible.

Regarding the ARV treatment, we apologised for not clearly mentioning what

excatly is. The said client was on d4t+3tc+NVP from LNJP Hopspital, after the

15days lead in dose of NVP, Dr observed the side

effect of NVP, then change NVP to EFV. The the same Dr. change d4t into TDF.

Certainly this (her regime) was not because of her delivery or for PMTCT as

mention earlier.

To avoid new infection, we believe that the client should recieved all the

possible measure, such as ARV or safe delivery measures.

When you have a choice shouldn't you go for cesarian section for HIV+ve pregnant

women who is also on ARV, even if the chances marginal? If its you will you take

that risk? Please advice us on this matter.

In our effort to help people gets the best treatment possible, if we make any

mistake, we are ready to apologise,learn and rectify.

Regards,

DNP+

e-mail: <dnpplus@...>

[Guest guest]

Dear all

Re: /message/7854

I want to mention that if efavirenz was prescribed to a pregnant mother then

please note that efavirenz is contraindicated for use in pregnant women as it

has been classified as class D (positive evidence of human foetal risk).

The consensus Guidelines for use of Antiretroviral Chemoprophylaxis in HIV

Positive Pregnant Women to Reduce Perinatal Transmission of HIV cleary mention

that in a HIV+ve woman of child bearing potential or if she is planning for

pregnancy and needs ART for her disease then she should not be prescribed

efavirenz. Furher if HIV+ve woman who is on efavirenz based regimen and becomes

pregnant then efavirenz should be withdrawn immediately.

Additionally although tenofovir has become a very commonly used agent for

non-pregnant HIV-infected persons, but its use in pregnancy remains limited

because of concern regarding potential fetal bone effects and is not recommended

in any guidelines also.

Regards

Dr. Alok Vashishtha M.D.

Nirmal Medical Foundation,

Hardwar

Cell:9897265635

e-mail: <dralokvashishtha@...>