Labour management and outcomes in HIV-positive women with no indications for caesarean delivery, France.
Article Type: Brief article
Subject: Cesarean section (Health aspects)
HIV infection (Drug therapy)
HIV infection (Patient outcomes)
HIV infection (Research)
Highly active antiretroviral therapy (Health aspects)
Women (Health aspects)
HIV infection in women (Drug therapy)
HIV infection in women (Patient outcomes)
HIV infection in women (Research)
Pub Date: 05/01/2011
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2011 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2011 Source Volume: 19 Source Issue: 37
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: France Geographic Code: 4EUFR France
Accession Number: 259077151
Full Text: In countries where highly active antiretroviral therapy (HAA T) is used widely, the need for mandatory caesarean delivery for HIV-positive women has been questioned. This retrospective case-control study assessed labour management and outcomes in 146 HIV-positive women on HAART who had no obstetric or virologic indications for caesarean delivery, and 146 controls at the Port-Royal Maternity Hospital, Paris, between 2001 and 2006. Cases and controls were matched for parity, previous caesarean delivery, and geographic origin. All participants had singleton pregnancies, term babies and cephalic presentations. The rates of caesarean and assisted vaginal delivery were similar in the two groups, but the episiotomy rate was significantly lower among the HIV-positive women (29.6% vs 45.6%, p=0.01), suggesting that episiotomy is used excessively in HIV-negative women. The indications for caesarean or assisted deliveries were different (p=0.01), with more caesareans performed in HIV-positive women due to fetal heartbeat abnormalities, perhaps because of the contraindication to fetal scalp blood sampling during labour when the woman is HIV-positive. There was no difference in mean birthweight, perineal laceration rates or neonatal outcome. Post-partum morbidity was similar for controls and HIV-positive women with CD4+ count >200. However, in the HIV-positive group, post-partum morbidity was higher in women with CD4+ count <200 (3.2% vs 22.2%, p=0.007). No case of mother-to-child transmission of HIV occurred. HIV-positive women with no contraindication to vaginal delivery seem to have the same labour outcomes as HIV-negative women, with no increase in mother-to-child transmission. (1)

(1.) Azria E, Kane A, Tsatsaris V, et al. Terra labor management and outcomes in treated HIV-infected women without contraindications to vaginal delivery and matched controls. International Journal of Gynecology and Obstetrics 2010; 111 : 161-64.
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