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Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010.
Am J Obstet Gynecol. 2013 Oct; 209(4):335.e1-335.e12.AJ

Abstract

OBJECTIVE

Elective cesarean section (CS) is a proven method to prevent mother-to-child transmission (MTCT), but is no longer recommended for women with antiretroviral therapy resulting in a low viral load (VL): <400 copies/mL in French and <1000 copies/mL in US guidelines. We sought to describe mode of delivery practices in human immunodeficiency virus (HIV)-infected women and their association with MTCT and postpartum complications.

STUDY DESIGN

All deliveries from HIV-1-infected women in the French Perinatal Cohort (Agence Nationale de Recherches sur le Sida/Enquête Périnatale Française) 2000 through 2010 (N = 8977) were analyzed, with additional details for 2005 through 2010 (n = 4717).

RESULTS

Vaginal deliveries increased from 25% in 2000 to 53% in 2010. Over 2005 through 2010, 4300 women had VL before delivery <400 copies/mL; among them only 49.3% delivered vaginally, 22.0% had nonelective CS, and 28.7% had elective CS. Elective CS were performed for scarred uterus in 45.4%, other obstetrical indications in 37.1%, and solely because of HIV in 15.7%. Of the 417 women with VL ≥400 copies/mL, 48.9% had elective CS as recommended, 25.9% had nonelective CS, and 25.2% had vaginal delivery. The MTCT rate did not differ according to the mode of delivery in term deliveries (≥37 gestational weeks) in 2000 through 2010: 0.3% after both vaginal delivery and elective CS with VL <50 copies/mL, 4.0% vs 5.3%, respectively, with VL ≥10,000 copies/mL. In case of preterm delivery, MTCT rates tended to be higher with vaginal delivery. Postpartum complications were more frequent following CS than vaginal deliveries (6.5% vs 2.9, P < .01).

CONCLUSION

Our findings suggest that HIV-infected women on antiretroviral therapy with low VL can safely opt for vaginal delivery in the absence of obstetrical risk factors.

Authors+Show Affiliations

Inserm, Center for Research in Epidemiology and Population Health U1018, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23791563

Citation

Briand, Nelly, et al. "Cesarean Section for HIV-infected Women in the Combination Antiretroviral Therapies Era, 2000-2010." American Journal of Obstetrics and Gynecology, vol. 209, no. 4, 2013, pp. 335.e1-335.e12.
Briand N, Jasseron C, Sibiude J, et al. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol. 2013;209(4):335.e1-335.e12.
Briand, N., Jasseron, C., Sibiude, J., Azria, E., Pollet, J., Hammou, Y., Warszawski, J., & Mandelbrot, L. (2013). Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. American Journal of Obstetrics and Gynecology, 209(4), e1-e12. https://doi.org/10.1016/j.ajog.2013.06.021
Briand N, et al. Cesarean Section for HIV-infected Women in the Combination Antiretroviral Therapies Era, 2000-2010. Am J Obstet Gynecol. 2013;209(4):335.e1-335.e12. PubMed PMID: 23791563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. AU - Briand,Nelly, AU - Jasseron,Carine, AU - Sibiude,Jeanne, AU - Azria,Elie, AU - Pollet,Justine, AU - Hammou,Yamina, AU - Warszawski,Josiane, AU - Mandelbrot,Laurent, Y1 - 2013/06/18/ PY - 2013/02/09/received PY - 2013/05/05/revised PY - 2013/06/12/accepted PY - 2013/6/25/entrez PY - 2013/6/25/pubmed PY - 2013/12/16/medline KW - cesarean section KW - human immunodeficiency virus KW - mode of delivery KW - mother-to-child transmission KW - viral load SP - 335.e1 EP - 335.e12 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 209 IS - 4 N2 - OBJECTIVE: Elective cesarean section (CS) is a proven method to prevent mother-to-child transmission (MTCT), but is no longer recommended for women with antiretroviral therapy resulting in a low viral load (VL): <400 copies/mL in French and <1000 copies/mL in US guidelines. We sought to describe mode of delivery practices in human immunodeficiency virus (HIV)-infected women and their association with MTCT and postpartum complications. STUDY DESIGN: All deliveries from HIV-1-infected women in the French Perinatal Cohort (Agence Nationale de Recherches sur le Sida/Enquête Périnatale Française) 2000 through 2010 (N = 8977) were analyzed, with additional details for 2005 through 2010 (n = 4717). RESULTS: Vaginal deliveries increased from 25% in 2000 to 53% in 2010. Over 2005 through 2010, 4300 women had VL before delivery <400 copies/mL; among them only 49.3% delivered vaginally, 22.0% had nonelective CS, and 28.7% had elective CS. Elective CS were performed for scarred uterus in 45.4%, other obstetrical indications in 37.1%, and solely because of HIV in 15.7%. Of the 417 women with VL ≥400 copies/mL, 48.9% had elective CS as recommended, 25.9% had nonelective CS, and 25.2% had vaginal delivery. The MTCT rate did not differ according to the mode of delivery in term deliveries (≥37 gestational weeks) in 2000 through 2010: 0.3% after both vaginal delivery and elective CS with VL <50 copies/mL, 4.0% vs 5.3%, respectively, with VL ≥10,000 copies/mL. In case of preterm delivery, MTCT rates tended to be higher with vaginal delivery. Postpartum complications were more frequent following CS than vaginal deliveries (6.5% vs 2.9, P < .01). CONCLUSION: Our findings suggest that HIV-infected women on antiretroviral therapy with low VL can safely opt for vaginal delivery in the absence of obstetrical risk factors. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/23791563/Cesarean_section_for_HIV_infected_women_in_the_combination_antiretroviral_therapies_era_2000_2010_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(13)00629-7 DB - PRIME DP - Unbound Medicine ER -