AFISE Unplanned vaginal deliveries

Unplanned vaginal deliveries among patients assisted in the PMTCT program by Baylor Romania in 2011 Issues Th e PMTCT program, also known at Baylor Romania as “Th e Precious Children”, has a high success rate (less than 1% transmission rate) and it combines a wide variety of medical and psychosocial interventions. Th e main goal is to assist the HIV infected pregnant women in going through all the steps established through the national and international standards in order to maximize the chances of having a healthy child. Description Th e monitoring process of the HIV infected pregnant women is made both through the ob/gyn medical ser- vice and the psychosocial department, therefore the interventions unfold at the COE and in the community. In Constanta the number of HIV infected pregnant women has been constantly high during past 3 years: 35 in 2009, 32 in 2010 and 34 in 2011. In spite of a thorough monitoring and of a high number of medical and psy- chosocial interventions, there has been a small but constant number of vaginal natural childbirths (4 in 2009, 2 in 2010 and 3 in 2011). At the current moment vaginal deliveries are not SOP in the Romanian PMTCT guidelines. Th erefore we de- cided to analyze the cases with unplanned vaginal deliveries from 2011 in order to extract data that can help to improve the program and to identify the cases of pregnant women that have a higher risk of not complying with all the steps of the PMTCT program. Lessons learned Th e analysis of the 3 cases was made using the medical and psychosocial data as recorded by the Baylor team. Th ere were both social and personal factors that lead to the outcome of a natural childbirth. Although one suc- cess indicator of the PMTCT program is the C section delivery, in the same time there are also other positive outcomes due to constant medical and psychosocial support. For example attaining and maintaining a unde- tectable VL during the pregnancy is a protective factor for both mother and the child. Also we have learned that the success can be perceived and defi ned diff erently by the patient vs the professional. Th erefore becom- ing aware of the patient’s views is key point in designing an intervention. Next steps We plan to expand the analysis for the cases from 2009 and 2010 in or- der to better understand similar so- cial vulnerability situations and see if there are red fl ags that could in- dicate increased probability for an unplanned vaginal delivery. Authors: Stefania Mihale, Ancuta Andrei, Mirela Paraschiv, Rodica Mihai, Corina Pop, Luiza Vlahopol, Emanoil Vasiliu – Baylor Black Sea Foundation - BIPAI Romania