HIV mother-to-child transmission, mode of delivery, and duration of rupture of membranes: experience in the current era.
OBJECTIVE
To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV).


METHODS
A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed.


RESULTS
Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV.


CONCLUSIONS
There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.
Department of Obstetrics and Gynecology, University of Toronto, 92 College Street, Toronto, ON, Canada M5G 1L4. siobhan.mark@gmail.com
Siobhan
S
Mark
Kellie E
KE
Murphy
Stanley
S
Read
Ari
A
Bitnun
Mark H
MH
Yudin
D000293:Adolescent; D000328:Adult; D000650:Amnion; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007745:Labor Onset; D009864:Ontario; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012189:Retrospective Studies; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult