Cesarean delivery for HIV-infected women: recommendations and controversies.
Two studies that were published in 1999 demonstrated that cesarean delivery before labor and before the rupture of membranes (elective cesarean delivery) reduces the risk of mother-to-child transmission of the human immunodeficiency virus (HIV). On the basis of these results, the American College of Obstetricians and Gynecologists and the US Public Health Service recommend that HIV-infected pregnant women with plasma viral loads of >1000 copies per milliliter be counseled regarding the benefits of elective cesarean delivery. Since the release of these guidelines, the cesarean delivery rate among HIV-infected women in the United States has increased dramatically. Major postpartum morbidity is uncommon, and cesarean delivery among HIV-infected women is relatively safe and cost-effective. However, a number of important questions remain unanswered, including whether cesarean delivery has a role among HIV-infected women with low plasma viral loads or who receive combination antiretroviral regimens.
Jamieson
Denise J
DJ
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. djj0@cdc.gov
Read
Jennifer S
JS
Kourtis
Athena P
AP
Durant
Tonji M
TM
Lampe
Margaret A
MA
Dominguez
Kenneth L
KL
D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D017048:Health Care Costs; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D018570:Risk Assessment