Optimal management of HIV-infected women during pregnancy and delivery: an audit of compliance with recommendations.
BACKGROUND
The improvement in quality of life of HIV-infected patients and a reduced risk of vertical transmission have led to an increase in the desire for pregnancy among infected women. We assessed whether local recommendations were followed by HIV-infected mothers and their reasons for noncompliance.


METHODS
Data on HIV-infected women who delivered between 2002 and 2006 in a large public university hospital in Brussels were collected and analyzed for compliance with recommendations and outcomes.


RESULTS
The evidence suggests that current recommendations were followed in two thirds of the 203 recorded deliveries, as the patients in question (n = 140) came to term with an undetectable viral load and an uninfected newborn. About half of these women delivered vaginally, and 67% had ruptured membranes for less than 4 hours and required no instrumental delivery. Among those for whom optimal conditions for delivery were not met, two newborns were infected.


CONCLUSIONS
The current recommendations were followed in only two thirds of the recorded deliveries. To improve results for the future, we have adapted our protocol both by starting antiviral therapy earlier and by assigning nurses to the patients' follow-up to try to promote better compliance to treatment during pregnancy.
Vandermaelen
Aline
A
Department of Obstetrics and Gynecology, Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
Barlow
Patricia
P
Manigart
Yannick
Y
Hainaut
Marc
M
Goetghebuer
Tessa
T
Levy
Jack
J
Gerard
Michèle
M
Rozenberg
Serge
S
D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D011256:Pregnancy Outcome / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood; D055815:Young Adult
D012367:RNA, Viral