Scheduled cesarean delivery and the prevention of human immunodeficiency virus transmission: a survey of practicing obstetricians.
OBJECTIVE
To characterize practice patterns among obstetrician-gynecologists with respect to delivery for human immunodeficiency virus (HIV)-seropositive women, following publication of the 1999 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion regarding scheduled cesarean delivery for HIV-infected patients.


METHODS
A 25-question, multiple-choice survey was mailed to 2000 randomly selected obstetrician-gynecologists: 1000 maternal-fetal medicine specialists and 1000 general obstetrician-gynecologists. Mailing addresses were obtained from the 1999-2000 editions of the Society for Maternal-Fetal Medicine (SMFM) and ACOG membership directories. Information was requested about general perceptions of the 1999 ACOG Committee Opinion and about practice patterns with respect to management of HIV disease in pregnancy. Data were analyzed by using descriptive statistics and the chi-square test. Any P values <.05 were considered significant.


RESULTS
After a single mailing we received 512 responses (25.6%), including 433 (43%) from SMFM members and 79 (8%) from ACOG members. Among the respondents, 47% disagreed with the current scientific validity of the 1999 ACOG Committee Opinion recommendation to offer cesarean delivery to all HIV-seropositive pregnant women. No statistically significant differences were detected in the demographic profiles, years of experience, or practice settings of participants who agreed with the scientific validity when compared to those who did not. Most respondents used viral load detection (87%) monitored on a trimester basis (67%) for clinical management decisions. Most practitioners (72%) do not recommend cesarean delivery for women who are compliant with antiretroviral therapy and who have undetectable viral loads regardless of CD4 counts. However, most practitioners (67%) do recommend cesarean delivery for those compliant women with detectable viral loads, irrespective of CD4 counts (67%).


CONCLUSIONS
There is considerable disagreement among practicing obstetricians with respect to the 1999 ACOG Committee Opinion recommendation to offer cesarean delivery to all HIV-seropositive women. Most physicians use viral load detection to assist with the counseling in delivery options for HIV-infected pregnant women.
Rowland
B L
BL
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29401-9901, USA.
Vermillion
S T
ST
Soper
D E
DE
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D018791:CD4 Lymphocyte Count; D002585:Cesarean Section; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011795:Surveys and Questionnaires; D019562:Viral Load
D019380:Anti-HIV Agents