C-Sections Recommended for HIV+ Pregnant Women

Abstract

Although cesarean births are rarely recommended before 39 weeks' gestation, the American College of Obstetricians and Gynecologists (ACOG), acting on new research, recommended in late July that all HIV-positive pregnant women should be offered scheduled cesarean deliveries at 38 weeks' gestation. The recommendation aims to reduce the risk of passing the AIDS-causing virus to newborns, ACOG indicated. The new recommendation results from published data that now show a scheduled cesarean, with zidovudine (ZDV) treatment, significantly reduces the risk of transmitting HIV to the infant to about 2 percent. Women with HIV who aren't taking ZDV and give birth vaginally have a 25 percent risk of passing the virus to their newborns. When both mother and baby, however, receive ZDV, the risk diminishes to between 5 and 8 percent. This risk is lowered even further-to about 2 percent-if both mother and newborn receive ZDV and the baby is delivered by a scheduled cesarean delivery. ACOG's recommendation comes at a time when the HIV infection rate in newborns has been steadily declining in the U.S., in large part because of increased testing of pregnant women and the increased use of prophylactic ZDV therapy for mothers and newborns. According to the Centers for Disease Control and Prevention, approximately 7,000 HIV-infected women give birth each year in the U.S. The precise method of HIV transmission from mother to newborn remains unknown, but research suggests that much of it occurs during labor and delivery. Performing a cesarean delivery at 38 weeks reduces the likelihood of onset labor or rupture of membranes. There's no benefit of having a cesarean delivery if either of these occur spontaneously. Also, ACOG points out that a woman's choice of whether to deliver by cesarean must be respected. Because there's an increased risk of morbidity with cesarean delivery among HIV-positive women, these women should be clearly informed about the risks. Furthermore, the latest combination drug regimens may reduce the risk of transmission to such a low level that cesarean delivery doesn't offer any additional benefit. Health care practitioners should discuss the option of a scheduled cesarean delivery as early as possible with every pregnant HIV-positive woman, whether she's taking antiviral therapy.