Management of breech presentation in areas with high prevalence of HIV infection.
OBJECTIVE
To provide recommendations for the management of breech presentation in areas of high prevalence of human immunodeficiency virus (HIV) infection.


METHODS
Review of relevant literature.


RESULTS
Studies show that elective cesarean section (CS) is safer than vaginal delivery for breech presentation, external cephalic version (ECV) at term increases the chance of vaginal cephalic delivery. Although there are no studies of the risk of mother-to-child transmission of HIV from ECV, indirect evidence suggests that any increased risk is likely to be very small.


CONCLUSIONS
Where CS is available and safe, HIV-positive women, or women who might be at risk of HIV, with a fetus at term with breech presentation, should be offered elective CS to reduce the risks of both vaginal breech delivery and mother-to-child HIV infection. HIV-negative women can be offered ECV at term to try to avoid CS. Where women do not have access to a safe CS, or prefer vaginal delivery, the benefit for both mother and child of attempting ECV at term is likely to outweigh the theoretical, very small, risk of facilitating HIV transmission.
Holmes
W R
WR
Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne 3001, Australia. holmes@burnet.edu.au
Hofmeyr
G J
GJ
D001946:Breech Presentation; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy