Current guidelines on management of HIV-infected pregnant women: impact on mode of delivery.
OBJECTIVE
To evaluate acceptance, feasibility and difficulties in the application of a policy of vaginal delivery in selected cases in HIV-infected women.


METHODS
HIV-infected women delivering March 2002 to December 2004 and enrolled in a prospective observational study in a University hospital tertiary care center were included. A vaginal delivery was not considered if labor before 36 weeks of pregnancy, preterm premature rupture of membranes, on non-highly active antiretroviral therapy (HAART) or viral load >1000copies/mL. Main outcome measures were mode of delivery, prematurity, acceptance of vaginal delivery and mother-to-child transmission of HIV infection.


RESULTS
The study included 91 pregnancies, with a total of 95 fetuses. Eighty percent (n=73) of women knew their HIV infection status before becoming pregnant and 57 (63%) were on HAART at conception. Median gestational age at delivery was 37 weeks (range 22-41). Twelve women delivered a live-born before 36 weeks, all with a caesarean section. Among 74 women who reached 36 weeks gestation, 47 (64%) met the pre-established criteria for vaginal delivery, of whom 21 (45%) delivered vaginally. The most common reason for not having a vaginal delivery was the woman's request for a caesarean section. No cases of HIV vertical transmission occurred (0/90, 95% CI 0-4.02%).


CONCLUSIONS
Recommending vaginal delivery among HIV-infected women in selected cases was well accepted, particularly once the policy became established. Nevertheless, a high proportion of HIV-infected women will continue to require caesarean section delivery.
Suy
Anna
A
Institut Clinic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, IDIBAPS, Barcelona, Spain.
Hernandez
Sandra
S
Thorne
Claire
C
Lonca
Montserrat
M
Lopez
Marta
M
Coll
Oriol
O
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors