Tropical Obstetrics and Gynecology 061 080

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HIV Over 1/3 of hospital patients positive


HIV Subsaharan Africa: 17% on therapy G-8: universal access by 2010


HIV test called “super VDRL” or “super” positive patients “super plus” or “coded”


HIV In pregnancy: tested on enrollment for prenatal care most HIV+ pregnant patients received AZT HIV+ mothers still encouraged to breastfeed Nonpregnant patients: wallet biopsy positive: ART wallet biopsy negative: no ART or plan

A face to go with the numbers: 

A face to go with the numbers 19 yo G1P0 at 32 weeks with HIV, TB, malaria admitted with fever, respiratory distress due to TB, hypoglycemia due to malaria sono IUGR, oligo hct 19- but BYOBD


no plan for HIV management A face to go with the numbers


Malaria in Pregnancy Worldwide 500,000,000 infections each year 2,000,000 deaths 75% of deaths are African children majority of remainder pregnant women In the US 1337 cases in the USA in 2002 227 in New York- highest of any state

Malaria in Pregnancy: 

Malaria in Pregnancy Stable Areas frequent mosquito bites acquired immunity in pregnancy: low parasitemia high placental sequestration Unstable Areas Rare mosquito bites no acquired immunity in pregnancy: heavy parasitemia low placental sequestration


Impaired placental function Placental Sequestration Low Birth Weight Risk of Newborn Mortality malaria Maternal Anemia Immune mom Nonimmune mom Parasitemia

Rationale for the Timing of Chemoprophyllaxis: 

Conception Birth 20 30 10 Weeks of gestation 16 Rationale for the Timing of Chemoprophyllaxis Fetal growth velocity  Quickening Source: WHO 2002. Last month Rx Rx


Malaria and Volunteers Weekly larium or daily doxycycline light colored clothing no perfumes Gin and tonics

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