Having a healthy baby from an HIV positive man. How to have a baby if one of the partners is HIV positive

Pregnancy with HIV infection is carefully planned. But there are times when a woman finds out about the infection already being pregnant. She will have antiretroviral therapy (ARV), monitoring the level of major antibodies, monitoring the condition of the fetus. In order to avoid health complications, it is necessary to follow the instructions of specialists, because the main task is the birth of a healthy child.

Is it possible to conceive with HIV infection?

Despite the risk of contracting an unborn child with HIV infection, in many families where one of the spouses, and sometimes both are immunocompromised, a decision is made to give birth to a baby. In such a difficult situation, even the method of conception can reduce the risk of infection of the baby. In fact, the germ cells of both parents are sterile, but the virus is found in abundance in biological fluids.

In this regard, doctors provide several methods of conception, in which this possibility is minimized:

1. If a woman is sick, she is invited to undergo an artificial insemination procedure - during ovulation, that is, the maturation and release of an egg ready for fertilization, pre-collected male sperm is introduced into the vagina.

2. For families and couples where a man is infected, several options are considered:

• Purification of seminal fluid An HIV-positive partner and direct insertion into the woman's vagina when a mature egg has already entered the abdominal cavity. This method reduces the risk of infection of a woman, and, consequently, a child.
• in vitro fertilization when, using the laparoscopic method, a female gamete is taken, and in men, spermatozoa are separated from the seminal fluid. Sex cells are fertilized artificially and then placed in the uterine cavity.
• The easy way- Unprotected sex is extremely rare. To do this, the day of ovulation must be accurately determined so that conception occurs for sure. Otherwise, with repeated attempts, the risk of infection of the woman increases.

3. There is also the safest option.- artificial conception of a woman through the seed of a healthy man, excluding any risks associated with the body of the mother and baby, but not all couples are ready for such a step, based on its moral and legal aspect.

How is the diagnosis carried out?

A timely detected infection can help a woman give birth to a normal baby, so it is advisable to take HIV tests even at the stage of pregnancy planning. For this, venous blood is taken from both the expectant mother and the alleged father.

The main diagnostic procedures in this case:

• ELISA- linked immunosorbent assay. Laboratory blood test to determine specific antigens and antibodies to HIV proteins. In the event that the serum gives a positive result twice in a row, an immunoblot test is performed, which excludes or confirms the infection.
• polymerase chain reaction- for such an examination, blood is taken, as well as a biomaterial of sperm and secretions from the female genital organs is taken. The purpose of the study is to establish the genotype (HIV-1, HIV-2), to determine the concentration of the virus in the body. The method helps to determine the presence of infection as early as 10-15 days after infection, but is usually used to confirm enzyme immunoassay screening.

During pregnancy, it is desirable for a woman to undergo an early diagnosis - within the first two months. Since there is a risk of later infection, it is recommended to conduct HIV tests at 30 and 36 weeks of gestation, as well as after childbirth.

The main symptoms of HIV infection in pregnant women

HIV infection can appear as early as 2 weeks after a woman is infected, but sometimes, when immunity is strong, signs of the disease appear much later - after a few months. Their single appearance may not raise any suspicion of a health hazard, so the diagnosis of immunodeficiency becomes unpleasant news.

In pregnant women in the acute stage, the following typical symptoms are observed:

• temperature rise to high values;
• severe myalgia - muscle pain;
• body aches, joint pain;
• bowel disorder in the form of diarrhea;
• skin rashes on the face, trunk and limbs;
• swollen lymph nodes.

A pregnant woman may have such general signs as weakness, fatigue, chills and fever, headache. They are easily confused with feeling unwell during a common cold.

After an exacerbation, a latent stage occurs, during which, practically, no obvious manifestations of the disease are detected. If the immunodeficiency state quickly becomes chronic, a woman may develop various diseases provoked by a fungal, bacterial and viral infection.

During pregnancy and HIV infection, it is realistic to endure and give birth to a healthy child only if the disease is at the initial and second stages of development. And only if the woman immediately begins treatment and antiretroviral prophylaxis.

How does HIV infection affect pregnancy?

It is known that HIV infection can adversely affect the course of pregnancy.

Pathology can provoke a woman:

• the development of opportunistic infections: tuberculosis, disruption of the urinary organs and other complications associated with immunodeficiency and adversely affecting pregnancy;
• defeat by herpes, syphilis, trichomoniasis and other sexual infections that can lead to stillbirth of a child;
• unsatisfactory formation of the fetus, and sometimes intrauterine death of the baby;
• violation of the fetal membrane and detachment of placental tissues;
• spontaneous miscarriages, which are much more common than in uninfected mothers.

Due to the influence of a dangerous infection, HIV patients are more likely to have premature births, and children are born with a lower weight. If pregnancy is accompanied by characteristic symptoms of the disease, the risk of a negative impact on the course of pregnancy also increases.

At the planning stage of conception, there is a high percentage that the embryo can be implanted outside the uterine cavity, which increases the risk for the life of the woman herself and the death of the fetus.

Transmission of the virus and its effect on the fetus

Despite the fact that there are cases of the birth of healthy offspring from an infected mother, the risk of infection of the child always exists.

Transmission of the HIV virus can occur:

• During pregnancy- the fetus can become infected if multiple pathological processes develop in the mother's body against the background of HIV, including bacterial infection of the placenta, amniotic fluid and umbilical cord. As a result of such a lesion, prenatal rupture of amniotic fluid, the birth of a dead child, and miscarriage can occur. Childbirth, at the same time, is distinguished by a difficult, protracted character.
• At the time of birth- passing through the birth canal, the baby is in close contact with the mucous tissues of the mother and any slight damage to the skin allows the virus to enter the body of the newborn. To protect it, a caesarean section is used at the 38th week of pregnancy, the operation reduces the risk of infection by half, but there is no guarantee in such a situation.
• After childbirth- the infection can pass from mother to baby through breast milk, the infection is not transmitted to the child in other ways.

As a result of infection during and after childbirth, the baby may experience pneumonia, chronic diarrhea, ENT diseases, encephalopathy, anemia, impaired kidney function, dermatitis, herpes, mental and physical developmental delay.

The course of pregnancy against the background of HIV

During pregnancy, due to the irresponsible attitude of the woman, as well as due to the complications associated with the infection, there is a high percentage of miscarriages, placental abruption, and stunted growth of the child.

First trimester

During this time, as throughout the gestation period, CD4 white blood cell counts are markedly reduced and many co-infections may occur. Most often, the expectant mother has to undergo treatment with special drugs that prevent the transmission of the virus to the baby. But usually treatment begins from 10 to 14 weeks, and before that the woman does not use any medications, as they can adversely affect the development of the baby.

Second trimester

Starting from the 13th week, intensive therapy with the main antiretroviral agents is prescribed, these are:

• Nucleosides and nucleotides - Phosphazid, Abacavir, Tenofovir, Lamivudine.
• Non-nucleoside reverse transcriptase inhibitors - Efavirenz, Nevirapine, Etravirine.
• HIV protease inhibitors - Nelfinavir, Ritonavir, Atazanavir.

In addition to drugs in the early and later stages of pregnancy, women are advised to take vitamin complexes, folic acid, and iron supplements.

third trimester

Highly active drugs are used to suppress the HAART retrovirus (the most effective Retrovir (Zidovudine) is prescribed at 7 months), they are often used in combination with each other, but can have significant side effects in the form of liver dysfunction, allergies, reduced blood clotting, dyspepsia. Therefore, doctors often adjust therapy or replace some drugs with others that are safer for the fetus.

With antiviral therapy throughout pregnancy, adherence to proper nutrition and other recommendations of doctors, the risk of infection is reduced to 2%, despite the fact that 30 out of a hundred children become infected without treatment - during pregnancy, childbirth and the postpartum period.

Management of pregnant women with HIV infection

When pregnancy occurs against the background of HIV infection, a responsible period begins for a woman, when all efforts should be directed to the birth of a healthy baby. All this time she will be under the supervision of doctors - the specialists of the AIDS center will conduct a complete medical examination, and will support the woman throughout the pregnancy, as well as her direct gynecologist-obstetrician and specialist in infectious diseases.

In this difficult time, a woman needs:

• take antiviral drugs;
• regularly visit an infectious disease specialist to identify dangerous diseases that occur due to a weakened immune system;
• if the fetus is in a normal state, agents can be prescribed to prevent spontaneous abortion, which often occurs at an early stage of gestation;
• it is mandatory to take monthly tests to study the state of the immune system, as well as a general and advanced blood test.

Continuous monitoring is necessary for the effective use of ARVs and ART drugs, in addition, this determines the most favorable time and option for childbirth.

Prevention

At conception, the prevention of infection of the child consists in the purification of the sperm of the infected father, in vitro fertilization, conception with the help of the sperm of a healthy donor. In women, antiviral treatment is acceptable to reduce the viral load before pregnancy is planned.

Throughout pregnancy, before and after childbirth, chemoprophylaxis of HIV infection with drugs is carried out.

If a woman is already carrying a child, the following preventive measures are applied:

• a pregnant woman with an immunodeficiency virus can have sexual intercourse only using a condom;
• when prescribing medical procedures, only disposable or maximally sterilized instruments should be used;
• perinatal invasive diagnostics is prohibited;
• prevention of diseases and complications associated with HIV infection;
• if the fetus is infected before 12 weeks, termination of pregnancy may be offered.

In relation to childbirth, optimal delivery is planned in advance. Basically, surgical removal of the newborn is used.

After the birth of the baby, the woman must stop breastfeeding and continue the course of antiviral treatment. In some cases, drug prophylaxis against a retrovirus is also prescribed for a newborn.

The desire of some couples to have a child cannot be stopped even by such a terrible diagnosis as HIV infection. But a woman needs to understand that she will have to go through a difficult path and make considerable efforts so that the baby is born healthy. This is a big responsibility and an undoubted risk that must be remembered.

Next article.

HIV is a relatively recent disease. Mankind met him about 30 years ago, but during this time the number of people infected with the virus has increased significantly. In total, there are more than 40 million people in the world suffering from this disease. The infection introduces many restrictions into the way of life of patients, and can affect the health of future children. Are HIV and pregnancy compatible?
The possible risks in this situation should not be underestimated, but the chance of having a healthy baby remains.

But planning and managing pregnancy in an HIV-positive woman is not an easy task, which requires the joint efforts of an obstetrician-gynecologist, an infectious disease specialist and, of course, the expectant mother herself.

There are two types of human immunodeficiency virus, HIV-1 and HIV-2. The first is more common and often turns into AIDS.

Both types of viruses are embedded in the DNA of cells and are currently incurable. Carrying an infection does not mean that a person will immediately begin to feel the manifestations of the disease. From infection to the transition of HIV to AIDS can take about 10 years.

The virus is transmitted from an infected person through:

• blood, for example, when transfused or using a single syringe;
• seminal fluid and vaginal discharge;
• breast milk.

Therefore, they can be transmitted sexually and when the blood of an infected person comes into contact with an open wound. HIV during pregnancy is dangerous because it can cross the placental barrier.

It is possible that the child is infected from the mother during gestation, it can also occur during childbirth and during breastfeeding.

Those most at risk of infection are people with drug addiction who use psychotropic substances intravenously, homosexuals, and those who are promiscuous without using drugs. But even well-to-do people can be infected.

The risk of “catching” HIV, albeit small, is present when carrying out various medical and cosmetic procedures associated with contact with blood, non-sterile instruments.

How does HIV infection affect the human body?

Once in the body, the virus is embedded in T-lymphocytes (white blood cells responsible for the immune system).

HIV uses the DNA of the cells to reproduce itself, causing them to die. So, many new particles of the virus appear in the body, and the immune system weakens.

With a significant decrease in the number of T-lymphocytes, a person cannot cope with conditionally pathogenic microorganisms.

Because of this, usually harmless bacteria become the cause of serious diseases. At this stage, the patient should start antiretroviral therapy, otherwise there is a risk of dying due to concomitant complications - meningitis, pneumonia, etc.

Symptoms and stages of the disease

The manifestations of the disease depend on how advanced it is. There are the following stages of progression of HIV infection:

1. incubation period. At this time, there are no symptoms, the patient may not be aware of the problem. Timely detection of the virus depends on whether a person monitors his health and whether he passes tests.
2. Stage of primary manifestations. The infected person develops a fever, lymph nodes increase. Colds are becoming more frequent, often with complications. The primary symptoms of HIV during pregnancy, such as chills, headache, fatigue, diarrhea, are easily confused with signs of other diseases. Therefore, the expectant mother needs to report her ailments to the doctor and undergo all the prescribed tests.
3. Generalized damage to the body. Viral, fungal or bacterial infections develop that affect the internal organs. The risk of developing malignant neoplasms increases.
4. Terminal stage. All body systems begin to fail, as a result, the patient dies from infections or tumors.

The duration of the passage of an infected person through these stages is individual. The average period from the moment of infection to the first manifestations of the disease is several years. Cases have been recorded when the first symptoms of the disease appeared within a year and even for a shorter period.

From the moment of infection to severe damage to the body, about 10 years pass, although the disease can be stopped at an early stage, if the patient follows the doctor's prescriptions.

Are pregnancy and HIV compatible? If we are talking about the first two stages, properly selected therapy makes it possible to endure and give birth to a healthy child, although there is no one hundred percent guarantee of this.

But with a rapidly progressing virus, conception is unlikely and irrational due to the serious condition of the woman.

How is HIV diagnosed?

The presence of the virus in the blood of a pregnant woman during the period of bearing a child is checked three times. For this, enzyme immunoassay is performed.

Multiple diagnostics is necessary, because the results of the study are not always reliable for a woman “in position”. Both false-negative and false-positive HIV testing during pregnancy is possible.

The reason that the virus will not be detected is a recent infection in which antibodies have not yet appeared.

A false positive result may be due to the presence of a woman's chronic diseases and malfunctions of the immune system. Therefore, even if the analysis indicates an HIV infection, doctors will not immediately scare the expectant mother, but will prescribe additional examinations.

Only monitoring the indicators in dynamics allows you to accurately determine whether a woman has a virus or not.

The risk of acquiring a child with HIV in pregnant women

If a woman is still diagnosed with HIV during pregnancy and the diagnosis is confirmed, the prognosis is affected by whether she receives the necessary therapy. In the absence of medical support, the probability of infection of a child during gestation and childbirth is 20-40%.

In the case of adequately selected and timely antiretroviral therapy, the chances of having a healthy baby increase. In infected women who are undergoing treatment and who refuse to breastfeed, from 2 to 8% of children receive the virus from the mother.

The baby is more likely to remain healthy if, having donated blood for HIV during pregnancy, the mother was able to identify the disease at an early stage.

Planning for pregnancy with HIV

A woman who knows about her positive status should approach conception deliberately. Pregnancy and HIV therapy in an infected mother go hand in hand. In preparation for conception, a woman needs to take a blood test to determine the viral load.

If the figures are high, first you need to achieve normalization of the number of lymphocytes and a decrease in HIV activity.

In the AIDS center where the expectant mother is seen, specialists will select the necessary therapy.

If the viral load is low and the woman has not recently received HIV treatment, it is recommended to refrain from taking antiviral drugs during the planning period and the first 3 months after conception.

Conception with HIV infection

In a couple where only one partner is infected, sexual intercourse must be carried out using a condom, so conceiving a child is difficult. If both parents have the virus, this simplifies the situation.

But even in this case, sexual intercourse without a condom is not always possible. Open sex is not recommended if partners have different strains of HIV. Overinfection may occur, which will not benefit the health of the parents.

So how do you combine HIV infection and pregnancy? When a woman is infected, for the safe conception of a child, the husband's sperm is collected in a sterile vessel. Then, the seed is used for fertilization, introducing it to the future mother artificially, under medical conditions.

If only the man is sick, there are several solutions. Since the concentration of HIV in seminal fluid is high, conception through unprotected intercourse is dangerous for a woman.

First way- achieve a decrease in the man's viral load to a minimum and try to get pregnant during this period in a natural way. The risk of infection remains, but it can be reduced by having intimacy without a condom only on ovulation days.

After all, the less unprotected sex, the higher the chances of avoiding infection.

Second way- use reproductive technologies and purify the sperm of a man in a special apparatus, separating the spermatozoa from the seminal fluid containing the virus.

There is also the possibility of fertilizing a woman with a donor's seed. But, for obvious reasons, not all couples decide on this. After all, it is important for many that the child is a continuation of a loved one.

How to control the virus during pregnancy?

Every mother who wishes her baby a happy future thinks about what to do if HIV and pregnancy are detected at the same time, and how to give birth to a healthy child.

All women with diagnosed disease should receive antiretroviral therapy consisting of Zidovudine or its combination with Nevirapine starting in the second trimester.

The following measures are also taken to prevent infection of the fetus:

1. Observation at the gynecologist and regular monitoring of the condition of the pregnant woman to minimize the risk. This is necessary because a premature baby, especially those born before 34 weeks, is more likely to become infected.
2. Prevention of diseases associated with HIV and their complications.
3. Exclusion of perinatal invasive diagnostics.
4. Planning for delivery. In most cases, a woman is shown planned. But if the viral load does not exceed 1000 in 1 µl, natural childbirth is allowed. At the same time, they try to avoid any obstetric surgical procedures - opening the fetal bladder, perineal incisions, etc.

Therapy for HIV during pregnancy, further rejection of breastfeeding and the appointment of a prophylactic course of antiviral drugs to the newborn, minimize the risk of infection.

It is impossible to understand whether a child is infected immediately after birth. Due to the ingestion of antibodies from the mother into his blood, tests for HIV in a baby can be positive up to 1.5 years. If after this period they disappear - the child is healthy.

HIV prevention in pregnant women

In order to prevent the virus in expectant mothers, it is recommended that a couple be tested for HIV before conception, as well as be examined for other infections. Upon learning of pregnancy, a woman needs to contact a gynecologist.

Early registration and timely examinations minimize the risk of complications and leave time to decide whether it is advisable to continue gestation when a dangerous disease is detected.

Pregnancy and HIV infection put a woman in front of a difficult choice. Despite all the achievements of medicine, there is no guarantee of the birth of a healthy child, so a gynecologist may recommend an abortion. It is up to the parents to agree to this or not. Doctors are obliged to support any of their choices.

If you have an HIV test positive during pregnancy, this is not a reason to panic. To establish the diagnosis, an additional examination at the AIDS center is required, because erroneous results are not uncommon.

Even if in the end the presence of the virus is confirmed, this is not a sentence, but a reason to urgently start treatment. People with HIV who are on antiretroviral therapy and are mindful of their health can live full lives.

Useful video: woman, child and HIV (doctors' opinion)

This is a chronic progressive infectious disease caused by a pathogen from the group of retroviruses and occurred before the conception of a child or during the gestational period. A long time passes latently. In the primary reaction, it is manifested by hyperthermia, skin rash, mucosal lesions, transient enlargement of the lymph nodes, and diarrhea. Subsequently, generalized lymphadenopathy occurs, weight gradually decreases, and HIV-associated disorders develop. Diagnosed by laboratory methods (ELISA, PCR, cellular immunity study). Antiretroviral therapy is used to treat and prevent vertical transmission.

HIV infection is a strict anthroponosis with a parenteral non-transmissible mechanism of infection from an infected person. Over the past 20 years, the number of newly diagnosed infected pregnant women has increased by almost 600 times and exceeded 120 per 100,000 examined. Most women of childbearing age were infected through sexual contact, the proportion of HIV-positive patients with drug addiction does not exceed 3%. Due to the observance of the rules of asepsis, sufficient antiseptic processing of instruments for invasive procedures and effective serological control, it was possible to significantly reduce the incidence of infection as a result of occupational injuries, blood transfusions, due to the use of contaminated instruments and donor materials. In more than 15% of cases, it is not possible to reliably determine the source of the pathogen and the mechanism of infection. The relevance of special support for HIV-infected pregnant women is due to the high risk of infection of the fetus in the absence of adequate restraining treatment.

The reasons

The causative agent of the disease is a human immunodeficiency retrovirus of one of two known types - HIV-1 (HIV-1) or HIV-2 (HIV-2), represented by many subtypes. Usually, infection occurs before the onset of pregnancy, less often - at the time or after the conception of a child, during gestation, childbirth, and the postpartum period. The most common route of transmission of an infectious agent in pregnant women is natural (sexual) through the mucous secretion of an infected partner. Infection is possible with the intravenous administration of narcotic drugs, violation of aseptic and antiseptic standards during invasive manipulations, performance of professional duties with the possibility of contact with the blood of a carrier or patient (health workers, paramedics, cosmetologists). During pregnancy, the role of some artificial ways of parenteral infection increases, and they themselves acquire certain specifics:

• Blood transfusion infection. With a complicated course of pregnancy, childbirth and the postpartum period, the likelihood of blood loss increases. Treatment regimens for the most severe bleeding involve the introduction of donor blood and preparations derived from it (plasma, erythrocyte mass). HIV infection is possible when using material tested for the virus from an infected donor in case of blood sampling during the so-called seronegative incubation window, which lasts from 1 week to 3-5 months from the moment the virus enters the body.
• instrumental infection. Pregnant patients are more likely than non-pregnant patients to undergo invasive diagnostic and therapeutic procedures. To exclude abnormalities in the development of the fetus, amnioscopy, amniocentesis, chorion biopsy, cordocentesis, placentocentesis are used. For diagnostic purposes, endoscopic examinations (laparoscopy) are performed, for therapeutic purposes - suturing of the cervix, fetoscopic and fetal drainage operations. Infection through contaminated instruments is possible during childbirth (when suturing injuries) and during caesarean section.
• Transplant transmission of the virus. Possible solutions for couples planning a pregnancy with severe forms of male infertility are insemination with donor sperm or its use for IVF. As in the case of blood transfusions, in such situations there is a risk of infection when using infected material obtained during the seronegative period. Therefore, for prophylactic purposes, it is recommended to use the sperm of donors who have successfully passed an HIV test six months after the donation of the material.

Pathogenesis

The spread of HIV throughout the body occurs with the blood and macrophages, into which the pathogen is initially introduced. The virus has a high tropism for target cells, the membranes of which contain a specific protein receptor CD4 - T-lymphocytes, dendritic lymphocytes, parts of monocytes and B-lymphocytes, resident microphages, eosinophils, cells of the bone marrow, nervous system, intestines, muscles, vascular endothelium, choriontrophoblast of the placenta, possibly spermatozoa. After replication, a new generation of the pathogen leaves the infected cell, destroying it.

Immunodeficiency viruses have the greatest cytotoxic effect on type I T4 lymphocytes, which leads to depletion of the cell population and disruption of immune homeostasis. A progressive decrease in immunity worsens the protective characteristics of the skin and mucous membranes, reduces the effectiveness of inflammatory reactions to the penetration of infectious agents. As a result, in the final stages of the disease, the patient develops opportunistic infections caused by viruses, bacteria, fungi, helminths, protozoal flora, tumors typical of AIDS (non-Hodgkin's lymphomas, Kaposi's sarcoma), autoimmune processes begin, eventually leading to the death of the patient.

Classification

Domestic virologists use in their work the systematization of the stages of HIV infection proposed by V. Pokrovsky. It is based on the criteria of seropositivity, the severity of symptoms, the presence of complications. The proposed classification reflects the gradual development of infection from the moment of infection to the final clinical outcome:

• Incubation stage. HIV is present in the human body, it is actively replicating, but antibodies are not detected, there are no signs of an acute infectious process. The duration of seronegative incubation is usually from 3 to 12 weeks, while the patient is contagious.
• Early HIV infection. The primary inflammatory response of the body to the spread of the pathogen lasts from 5 to 44 days (in half of the patients - 1-2 weeks). In 10-50% of cases, the infection immediately takes the form of asymptomatic carriage, which is considered a more favorable prognostic sign.
• Stage of subclinical manifestations. Virus replication and destruction of CD4 cells lead to a gradual increase in immunodeficiency. A characteristic manifestation is generalized lymphadenopathy. The latent period in HIV infection lasts from 2 to 20 years or more (on average, 6-7 years).
• Stage of secondary pathology. The depletion of protective forces is manifested by secondary (opportunistic) infections, oncopathology. The most common AIDS-indicator diseases in Russia are tuberculosis, cytomegalovirus and candidal infections, pneumocystis pneumonia, toxoplasmosis, and Kaposi's sarcoma.
• Terminal stage. Against the background of severe immunodeficiency, pronounced cachexia is noted, there is no effect from the therapy used, the course of secondary diseases becomes irreversible. The duration of the final stage of HIV infection before the death of the patient is usually no more than a few months.

Practicing obstetricians and gynecologists often have to provide specialized care to pregnant women who are in the incubation period, at an early stage of HIV infection or its subclinical stage, less often when secondary disorders appear. Understanding the characteristics of the disease at each stage allows you to choose the optimal scheme for managing pregnancy and the most appropriate method of delivery.

HIV symptoms in pregnant women

Since during pregnancy, most patients are diagnosed with stages I-III of the disease, pathological clinical signs are absent or look nonspecific. During the first three months after infection, 50-90% of those infected have an early acute immune reaction, which is manifested by weakness, slight fever, urticarial, petechial, papular rash, inflammation of the mucous membranes of the nasopharynx, vagina. Some pregnant women have swollen lymph nodes and develop diarrhea. With a significant decrease in immunity, short-term, mild candidiasis, herpes infection, and other intercurrent diseases may occur.

If HIV infection occurred before pregnancy, and the infection has developed to the stage of latent subclinical manifestations, the only sign of the infectious process is persistent generalized lymphadenopathy. A pregnant woman has at least two lymph nodes with a diameter of 1.0 cm or more, located in two or more groups that are not interconnected. When touched, the affected lymph nodes are elastic, painless, not connected to the surrounding tissues, the skin over them has an unchanged appearance. The increase in nodes persists for 3 months or more. Symptoms of secondary pathology associated with HIV infection are rarely detected in pregnant women.

Complications

The most serious consequence of pregnancy in an HIV-infected woman is perinatal (vertical) infection of the fetus. Without adequate restraining therapy, the probability of infection of the child reaches 30-60%. In 25-30% of cases, the immunodeficiency virus passes from mother to child through the placenta, in 70-75% - during childbirth when passing through an infected birth canal, in 5-20% - through breast milk. HIV infection in 80% of perinatally infected children develops rapidly, and AIDS symptoms appear within 5 years. The most characteristic signs of the disease are malnutrition, persistent diarrhea, lymphadenopathy, hepatosplenomegaly, developmental delay.

Intrauterine infection often leads to damage to the nervous system - diffuse encephalopathy, microcephaly, cerebellar atrophy, deposition of intracranial calcifications. The likelihood of perinatal infection increases with acute manifestations of HIV infection with high viremia, a significant deficiency of T-helpers, extragenital diseases of the mother (diabetes mellitus, cardiopathology, kidney disease), the presence of sexually transmitted infections in a pregnant woman, chorioamnionitis. According to obstetrics specialists, HIV-infected patients are more likely to have a threatened miscarriage, spontaneous miscarriages, premature births, and increased perinatal mortality.

Diagnostics

Taking into account the potential danger of the patient's HIV status for the unborn child and attending medical personnel, the test for the immunodeficiency virus is included in the list of recommended routine examinations during pregnancy. The main tasks of the diagnostic stage are to identify possible infection and determine the stage of the disease, the nature of its course, and prognosis. For diagnosis, the most informative laboratory methods of research:

• Linked immunosorbent assay. Used for screening. Allows you to detect antibodies to the human immunodeficiency virus in the blood serum of a pregnant woman. Negative in the seronegative period. It is considered a method of preliminary diagnosis, it requires confirmation of the specificity of the results.
• immune blotting. The method is a kind of ELISA, which makes it possible to determine in the serum antibodies to certain antigenic components of the pathogen, distributed by molecular weight by phoresis. It is a positive immunoblot result that is a reliable sign of the presence of HIV infection in a pregnant woman.
• PCR diagnostics. Polymerase chain reaction is considered a method of early detection of the pathogen with a period of infection of 11-15 days. With its help, viral particles are determined in the patient's serum. The reliability of the technique reaches 80%. Its advantage is the possibility of quantitative control of copies of HIV RNA in the blood.
• Study of the main subpopulations of lymphocytes. The probable development of immunosuppression is evidenced by a decrease in the level of CD4-lymphocytes (T-helpers) to 500/µl or less. The immunoregulatory index, which reflects the ratio between T-helpers and T-suppressors (CD8-lymphocytes), is less than 1.8.

When a previously unexamined pregnant woman from marginal contingents is admitted for childbirth, it is possible to conduct an express HIV test using highly sensitive immunochromatographic test systems. For a planned instrumental examination of an infected patient, non-invasive diagnostic methods are preferred (transabdominal ultrasound, dopplerography of the uteroplacental blood flow, cardiotocography). Differential diagnosis at the stage of early reaction is carried out with ARVI, infectious mononucleosis, diphtheria, rubella, and other acute infections. If generalized lymphadenopathy is detected, it is necessary to exclude hyperthyroidism, brucellosis, viral hepatitis, syphilis, tularemia, amyloidosis, lupus erythematosus, rheumatoid arthritis, lymphoma, and other systemic and oncological diseases. According to the indications, the patient is consulted by an infectious disease specialist, a dermatologist, an oncologist, an endocrinologist, a rheumatologist, a hematologist.

Treatment of HIV infection in pregnant women

The main objectives of pregnancy management in case of infection with the human immunodeficiency virus are infection suppression, correction of clinical manifestations, and prevention of infection of the child. Depending on the severity of symptoms and the stage of the disease, massive polytropic therapy with antiretroviral drugs is prescribed - nucleoside and non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors. Recommended treatment regimens differ at different gestational ages:

• When planning a pregnancy. To avoid embryotoxic effects, women with HIV-positive status should stop taking special drugs before the onset of a fertile ovulatory cycle. In this case, it is possible to completely eliminate the teratogenic effect in the early stages of embryogenesis.
• Up to 13 weeks pregnant. Antiretroviral drugs are used in the presence of secondary diseases, a viral load exceeding 100 thousand copies of RNA / ml, a decrease in the concentration of T-helpers less than 100 / μl. In other cases, pharmacotherapy is recommended to be discontinued to exclude negative effects on the fetus.
• 13 to 28 weeks. When diagnosing HIV infection in the second trimester or when an infected patient is treated at this time, active retroviral therapy is urgently prescribed with a combination of three drugs - two nucleoside reverse transcriptase inhibitors and one drug from other groups.
• From 28 weeks to delivery. Antiretroviral treatment continues, chemoprevention of the transmission of the virus from a woman to a child is being carried out. The most popular scheme is in which, from the beginning of the 28th week, the pregnant woman constantly takes zidovudine, and once before childbirth - nevirapine. In some cases, backup schemes are used.

The preferred method of delivery for a pregnant woman diagnosed with HIV infection is vaginal delivery. When they are carried out, it is necessary to exclude any manipulations that violate the integrity of the tissues - amniotomy, episiotomy, the imposition of obstetric forceps, the use of a vacuum extractor. Due to a significant increase in the risk of infection of the child, the use of drugs that cause and enhance labor activity is prohibited. A caesarean section is performed after 38 weeks' gestation for unknown viral load, viral load greater than 1,000 copies/mL, no antenatal antiretroviral therapy, and inability to administer retrovir during labor. In the postpartum period, the patient continues to take the recommended antiviral drugs. Since breastfeeding is prohibited, lactation is suppressed with medication.

Forecast and prevention

Adequate prevention of HIV transmission from pregnant to fetus can reduce the level of perinatal infection to 8% or less. In economically developed countries, this figure does not exceed 1-2%. Primary prevention of infection involves the use of barrier contraceptives, sexual life with a permanent verified partner, refusal to use injecting drugs, the use of sterile instruments when performing invasive procedures, and careful control of donor materials. To prevent infection of the fetus, it is important to timely register an HIV-infected pregnant woman with a antenatal clinic, refuse invasive prenatal diagnostics, choose the optimal antiretroviral treatment regimen and method of delivery, and prohibit breastfeeding.

Just two decades ago, the desire of an HIV-positive woman to have a child was considered, if not illegal, but shameful and immoral.

The experts were convinced that HIV infection and pregnancy- the concepts are completely incompatible. And the possibility of transmission of infection from mother to baby frightened the HIV-infected women themselves. In addition, childbirth could be of great danger to the mother. However, in recent years, completely new means have appeared to fight HIV, and today a woman with such a diagnosis is quite capable of conceiving, enduring and giving birth to an absolutely full-fledged child.

How to recognize HIV during pregnancy?

The incubation period of this disease can last from two weeks to several months, depending on the state of immunity. The first signs of HIV can be quite vague and most often women simply ignore them at an early stage. Most women learn about the diagnosis only in its acute phase, which is characterized by:

• a strong rise in temperature;
• the appearance of pain in the muscles;
• discomfort in the joints and throughout the body;
• various types of disorders of the stomach;
• rashes on the skin, body and limbs;
• changes in the size of the lymph nodes.

Very often, a pregnant HIV-positive woman feels weakness, headache, chills, fatigue. All these symptoms are also inherent in absolutely healthy pregnant women. The acute stage gradually flows into the latent one, when the disease practically does not manifest itself. In the absence of proper treatment, a woman's immunity is rapidly falling, and her body becomes especially susceptible to various viruses, fungi and infections.

Important! The chance to endure and give birth to a full-fledged child exists in women whose disease is in the first or second stage of development. In this case, a prerequisite is the continuous treatment of the disease.

Diagnosis of the disease

If a future mother is diagnosed with HIV in a timely manner, this will give her every chance to successfully conceive, bear and give birth to a healthy child. That is why it is so important to undergo a complete examination at the stage of pregnancy planning. HIV infection can be detected by the following methods:

1. polymerase chain reaction- for this it is necessary to take a blood sample, as well as examine the semen and body fluids of both partners. Thus, it is possible to establish the presence and type of HIV infection, if any, as well as its concentration. This method allows you to diagnose the disease as early as two weeks after the moment of infection.
2. ELISA screening- the most commonly used and effective method for determining HIV. To do this, partners donate venous blood for the presence of specific antibodies to HIV. If such testing gives a positive result twice, then the presence of infection is refuted or confirmed by a special additional test (immunoblot test).

Important! HIV testing is recommended during the first trimester of pregnancy. However, the risk of transmission of the disease remains throughout pregnancy, so it should be examined at a later date, as well as after the birth of the child.

Impact of HIV on pregnancy

The presence of HIV infection can adversely affect the course of pregnancy. In some cases, HIV-positive pregnant women may develop:

• tuberculosis, pneumonia, various diseases of the genitourinary system;
• chlamydia, herpes, syphilis and other sexual infections;
• abnormal intrauterine development of the fetus, in rare cases - fetal death;
• placental abruption or violation of the integrity of the amniotic membrane;
• frequent miscarriages.

Many HIV-infected people have preterm births, resulting in underweight babies. In addition, during the planning process, there is a high probability of implantation of the embryo outside the uterine cavity - we are talking about an ectopic pregnancy.

Ways of transmission of HIV infection

Pregnancy in an HIV-infected woman must be carefully planned. However, it also happens that the expectant mother finds out about her diagnosis while already in position. In this case, she will have to undergo a course of treatment with special drugs aimed at combating the virus, regularly monitor the level of antibodies in the body, and also monitor the development process and the condition of the unborn child.

Of course, the very combination of pregnancy and HIV is extremely dangerous for both the unborn child and the mother, but if a woman is ready to strictly comply with all the doctors' prescriptions and has an idea of ​​the risks, she has every chance of becoming a happy mother.

Exists three main ways that HIV can be transmitted from mother to child:

1. Through the blood- during the period of gestation, the fetus and the expectant mother have a common circulatory system, so there is a possibility of transmission of infection during their stay in the womb.
2. During childbirth- when the maximum allowable infection values ​​are reached, there is a chance of HIV transmission during childbirth through the amniotic fluid. In most cases, delivery in HIV-positive pregnant women occurs by caesarean section.
3. During the period of breastfeeding- The baby can get HIV from the mother while breastfeeding. The risk of transmission in this case is about 25%, because without special precautions, breast milk contains a fairly high concentration of infection. Most often, HIV-infected women in labor prefer artificial feeding.

How to avoid passing HIV to a child?

Many families suffering from the human immunodeficiency virus express a desire to reproduce a child, sometimes even more than one. In this case, even the most seemingly insignificant details must be taken into account, since the possibility of infection of the fetus exists even during the conception process. Of course, the germ cells of the parents cannot be the source of infection, but the infection is present in the fluids of both partners.

There are several ways to conceive relatively safely for such couples. In cases where only a woman is the carrier of the virus, artificial insemination can be performed on her, namely, we are talking about artificial insemination. In families where the spouse is infected, one of the following fertilization options can be resorted to:

1. Sexual intercourse during ovulation- the method is used quite rarely, since the risk of infection of a woman remains quite high.
2. ECO- in this case, the fusion of the sperm and the egg occurs in the laboratory, after which the developing embryo is placed in the woman's uterine cavity.
3. The seminal fluid of the partner is subjected to special purification, and is inserted into the partner's vagina during ovulation. Thus, the threat of transmission of the virus to a woman and an unborn child is significantly reduced.

Important! The safest method of conception for HIV-infected women is artificial conception with healthy donor material. However, far from all couples are ready to take this step.

In the process of gestation, childbirth and during the period of feeding, the probability of infection of the child is quite high (about 25%) if proper precautions are not taken. Modern techniques are able to reduce this probability to about 2-3%, and this is a very significant shift. What needs to be done for this?

1. First of all, do not neglect taking HIV medications. As a rule, a woman with this terrible diagnosis must, throughout the entire period of pregnancy and after childbirth, take funds that contain a certain substance aimed at combating HIV. Thus, the chance of transmission of the disease is significantly reduced.
2. Childbirth by caesarean section. In this case, it is possible to significantly minimize the contact of the child with the mother's fluids. Natural childbirth in HIV-infected people is allowed, but only in certain cases.
3. Artificial feeding. An HIV-infected woman will most likely have to stop breastfeeding her baby. To date, on the shelves of children's stores there is a fairly wide range of nutrition for newborns, which practically does not differ in properties from natural breast milk.

Is pregnancy dangerous for the woman herself?

According to statistics, pregnancy in most cases is not able to negatively affect the condition of an HIV-infected expectant mother. However, some anti-HIV drugs must be avoided during pregnancy because they are extremely harmful to the development of the fetus. In addition, like any healthy woman, a woman with HIV infection should pay special attention to her lifestyle throughout pregnancy, namely:

• completely abandon bad habits - smoking and alcohol;
• do not take drugs;
• review your diet, making it as balanced as possible;
• strictly follow the rules for receiving funds aimed at combating HIV.

Important! There are drugs that can cause the development of congenital anomalies in the fetus, which is why their intake must first be discussed with your doctor!

In the Department of Reproductology, Lazarev Alexander Pavlovich respects and understands the desire of HIV-positive women to have their own children. And fortunately, even such a terrible diagnosis is not able to put an end to the opportunity to give a new life. However, every woman with HIV must be aware that she and her husband will have to go through a difficult long journey and make a lot of efforts so that their child is born healthy.

Modern medicine is able to reduce the probability of transmission of HIV infection from mother to child to 2%. From now on, HIV is not a sentence at all, and in our time this disease does not put an end to the dream of motherhood at all. You can give yourself and your spouse a completely healthy strong baby who will give you a lot of happiness and push negative thoughts about your illness into the background.

In recent years, the number of women of childbearing age among HIV-infected women has increased significantly. HIV infection in a pregnant woman invariably presents significant difficulties for the obstetrician. Doctors are faced with the task of reducing the risk of transplacental transmission of the virus to the fetus and maintaining the health of the expectant mother. Pregnancy management should be carried out by an obstetrician and an infectious disease virologist.

What provokes / Causes of HIV infection in pregnant women:

AIDS is a disease associated with severe impairment of T-cell immunity in adults and T- and B-cell immunity in children. The causative agent of AIDS is AIDS virus(HIV) - RNA-containing virus. There are two types of HIV - HIV-1 and HIV-2. Of these, HIV-1 is the most common. It has been proven that HIV-2 infection occurs less frequently, it has a longer incubation period, and it is less virulent than HIV-1. With HIV-2 infection, the disease develops in 4-10% of those infected, with HIV-1 infection - in 20-40%.

A feature of the virus is the ability to synthesize, on the basis of the RNA itself, the DNA necessary for the reproduction of the virus using the enzyme reverse transcriptase (revertase). The virus has a tropism for cells of the lymphoid series - T-helpers (CD4), macrophages, monocytes and neurons, in which it is able to integrate into chromosomal DNA, persist for a long time, disrupt their function and cause immune restructuring. Virus replication begins after immune stimulation of T-lymphocytes in connection with reinfection or under the influence of other acute and chronic diseases. Rapid reproduction causes the death of CO4 cells. In this case, a functional deficiency of T-cell immunity occurs, which leads to a violation of the antigen-specific differentiation of B-lymphocytes and their polyclonal activation. This is manifested in an increase in the concentration of immunoglobulins in the peripheral blood, and the resulting dysfunction of B-lymphocytes with the development of their functional deficiency causes a violation of the synthesis of specific antiviral antibodies. After multiplying in the cells of the immune system, HIV spreads hematogenously throughout the body and can be isolated from any environment in the body. It is able to maintain its viability for a long time in blood plasma devoid of cellular elements, which explains the high probability of its transmission through a syringe.

HIV is heterogeneous, has a high degree of genetic variability, quickly dies when boiled, from exposure to disinfectants, but is resistant to ionizing radiation and ultraviolet radiation.

The source of infection are AIDS patients and virus carriers. At the same time, the carrier period can be very long (years), and during the first years after infection, the carrier can be seronegative due to the lack of virus replication. Ways of infection transmission - sexual (75% of those infected), transfusion (through infected blood products, drug addicts), transplacental, intranatal, postnatal (through infected milk and through close household contacts between mother and newborn).

HIV has been isolated from many body fluids, including urine, saliva, and tears, but so far only cases of transmission through blood, semen, vaginal secretions, and breast milk have been described. "Wet kisses" can pose some danger. The risk of sexual transmission of HIV infection increases with the presence of other STIs.

Symptoms of HIV infection in pregnant women:

The incubation period for AIDS ranges from a few months to 5 years or more. Transmission of HIV does not necessarily lead to the development of the disease. In 60-70% of those infected, the infection is asymptomatic for a number of years. 2-8% of those infected each year develop clinical signs of AIDS. In this case, the disease has 6 stages: incubation period, acute stage of the disease, latent period, persistent generalized lymphadenopathy, AIDS-associated symptom complex and AIDS itself. On average, the time of development of AIDS from the moment of infection is 10 years, the disease can debut at any stage, including AIDS, it can stop at any stage without reaching AIDS.

Diagnosis of HIV infection in pregnant women:

Based on the identification of risk factors or clinical symptoms with confirmation of the diagnosis using serological tests. PCR is not yet used as a standard diagnostic test to detect the virus genome in lymphocytes. Serological studies are carried out using enzyme-linked immunosorbent assay in combination with confirmatory tests. More specific tests - determination of HIV proviral DNA, viral load and number of helpers, T-cell function.

In children, serodiagnosis is difficult due to frequent false positive results due to transplacental transfer of maternal antibodies.

Treatment of HIV infection in pregnant women:

Pregnancy and childbirth in HIV-infected people. The course of HIV infection may accelerate and worsen during pregnancy due to the immunosuppression inherent in the gestational process. The course of pregnancy is also often complicated. Attention is drawn to the high frequency of cervical intranatal neoplasia, symptomatic candidiasis, and an increased frequency of preterm birth.

The most dangerous complication of pregnancy is perinatal infection of the fetus with HIV infection, which without appropriate therapy is observed in 30-60% of cases, regardless of the presence of symptoms of the disease in the mother. Vertical infection with HIV can occur during pregnancy, childbirth, and postnatally. HIV can be transmitted as a cell-bound virus or as a free virus. Also, HIV-infected cells of the placenta act as a source of infection. In this case, 3 ways of transferring the virus to the fetus are possible.

Transplacental transfer of free virions as a result of various damage to the fetoplacental barrier (placental abruption, placentitis, FPI) with subsequent interaction of the virus with fetal CO4-lymphocytes.

• Primary infection of the placenta and accumulation of the virus in Hofbauer cells, followed by the reproduction of the virus and its transfer to the fetus.
• Intranatal infection of the fetus through contact of the mucous membranes of the fetus with infected blood or secretions of the birth canal.
• Postnatally infected from 15 to 45% of children from HIV-infected mothers. Most of these women are unaware of their infection and mostly infect their children through breastfeeding.

Maternal risk factors for vertical transmission: a large viral load of the body with a high level of virus in plasma, the detection of a virulent HIV isolate, a low number of T-helpers.

Autopsy of the tissues of spontaneous miscarriages in HIV-positive mothers reveals that HIV can cause intrauterine infection as early as the first trimester. More than half of all cases of vertical transmission of infection occur immediately before childbirth or during childbirth, and antenatal infection in most cases occurs in the third trimester.

Fetal HIV infection or a newborn leads to the development of an immunodeficiency in him, which differs from that in adults. Up to 5 years of life, AIDS develops in 80% of children infected with HIV perinatally. The first signs of intrauterine HIV infection are malnutrition (in 75% of cases) and various neurological symptoms (in 50-70% of cases). Soon after birth, persistent diarrhea, lymphadenopathy (90%), hepatosplenomegaly (85%), oral candidiasis (50%), and developmental delay (60%) join. Chronic pneumonia and recurrent infections are common. Symptoms of CNS damage are associated with diffuse encephalopathy, cerebellar atrophy, microcephaly, deposition of intracranial calcifications.

Distinguish between early and late HIV infection. Approximately 20-30% of children infected vertically may have an early onset severe form of the disease - a rapidly progressive form. These patients have a high viral load at birth and in the first months of life, already in infancy, they experience a rapid loss of helper T-lymphocytes.

In 70-75% of children infected vertically, a slowly progressive form of infection is observed: a low viral load at birth, a stable number of helpers for a long time, the absence of clinical manifestations or the presence of only mild symptoms (lymphadenopathy, mumps), as well as recurrent bacterial infections. The proportion of children with a slowly progressive form of the disease that has reached the stage of AIDS is approximately 5-10% per year. In 5% of children, clinical and immunological symptoms do not progress. This is associated with genetic factors, the preservation of immunocompetence and the persistence of low-virulence HIV isolates.

Causes of death in young children with AIDS are generalized CMV infection or sepsis caused by gram-negative or opportunistic bacteria, in older children, as in adults, a combination of pneumocystosis with Kaposi's sarcoma.

More recently, the detection of antibodies to HIV in the blood of a pregnant woman was an indication for termination of pregnancy due to the high risk of perinatal infection. However, at present, the appointment of specific antiviral drugs to pregnant women can reduce the risk of intrauterine infection to 5-10%. Such an antiviral drug in pregnant women is zidovudine, an analogue of HIV nucleosides. It is prescribed in doses of 300 to 1200 mg / day. The facts of the teratogenic effect of zidovudine have not been established. Opportunistic infections are treated in the same way as in non-pregnant women.

HIV infection in the mother is not an indication for caesarean section in women receiving antiviral drugs, since the risk of infection of the fetus during caesarean section and vaginal delivery is approximately the same. In HIV-infected women who have not received therapy during pregnancy, abdominal delivery is currently the method of choice.

In the case of vaginal delivery, you should follow the rules for managing childbirth in case of any viral infections: reduce the duration of the anhydrous period and avoid any obstetric procedures that injure the skin of the fetus. To prevent infection at the time of delivery, zidovudine is taken in capsules. Breastfeeding is contraindicated in HIV infection to prevent postnatal infection.

It is believed that when a set of the following recommendations is followed, the risk of infection of a child does not exceed 3%:

• antiretroviral therapy prescribed to the mother during the second half of pregnancy, to the newborn - during the first 6 weeks of life;
• planned caesarean section;
• refusal to breastfeed.

Prevention of HIV infection in pregnant women:

Specific prevention, unfortunately, has not yet been developed. In order to reduce the incidence of perinatal infection in the Russian Federation, a mandatory examination of all pregnant women for HIV infection three times during pregnancy has been adopted: at registration, at 24-28 weeks and before childbirth. Testing for HIV of sexual partners of pregnant patients is also recommended. If at least one of the partners is diagnosed with HIV infection, they should independently decide whether it is advisable to prolong such a pregnancy, knowing the degree of risk of infection of the fetus. Due to the widespread prevalence of HIV infection and the risk of transmission through breast milk, milk donation is prohibited in many countries.

Thus, the following is used in the prevention of vertical transmission of HIV infection.

• Obstetric activities:
  • HIV testing;
  • exclusion of invasive prenatal diagnosis in pregnant women with HIV;
  • planned caesarean section before the onset of labor;
  • during natural childbirth:
    • exclusion of early amniotomy,
    • disinfection of the birth canal,
    • prevention of dissection and rupture of the perineum.
• Therapeutic measures:
  • treatment of a pregnant woman and a newborn with zidovudine.
• Pediatric activities:
  • adequate primary treatment in the maternity ward;
  • refusal to breastfeed.

Which doctors should you contact if you have HIV infection in pregnant women:

Are you worried about something? Do you want to know more detailed information about HIV infection in pregnant women, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

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You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

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Fast and rapid delivery

Management of pregnancy and childbirth in the presence of a scar on the uterus

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Group A streptococcal infections in pregnant women

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candidiasis in pregnant women

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Cephalhematoma with birth trauma

Rubella in pregnant women

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lactation mastitis in the postpartum period

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