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Mode of delivery in HIV-infected women in France between 2005 and 2009
Abstract Content:
Background: Since 2002,
French guidelines for prevention of mother-to-child transmission of HIV have recommended
vaginal delivery in case of maternal viral load near delivery < 400 cp/mL and
planned caesarean
section (CS) in case of viral load >400 cp/mL. We aimed to describe
frequency of, and factors associated with mode of delivery.
Methods: All pregnancies of HIV1-infected women enrolled between 2005 and 2009 in the detailed component of the national French Perinatal Cohort (ANRS-CO1-EPF) were categorized into two groups according to maternal viral load near delivery: uncontrolled (>400copies/mL: N=254) and controlled (< 400copies/mL: N=2548).
Results: For women with uncontrolled viral load, the main mode of delivery was planned CS as recommended (49.6%). Nevertheless 24.8% of women delivered vaginally, much more frequently in premature than term deliveries (82.8% vs 18.4%, p< 0.01).
For women with controlled viral load, 48.0% delivered vaginally and 30.6% had a planned CS. In that group, vaginal delivery was associated with Sub-Saharan Africa origin, multiparity, characteristics of maternity and indicators of optimal follow up (HIV diagnosed before the last gestational trimester, undetectable VL < 50cp/ml near delivery). Previous caesarean was mentioned as only or associated indication for 41.9% of the planned CS with well controlled viral load. Other obstetrical or maternal indication in lack of repeat caesarean concerned 23.8% of them. HIV infection was the only indication reported for 18%.
Prolonged hospitalization and maternal post-partum complications were more frequent in case of caesarean than vaginal delivery (p< 0.01), with a higher proportion of prolonged hospitalisation in case of uncontrolled viral load.
Conclusion: Among women with VL >400 cp/mL, one quarter delivered vaginally, but, overall, this situation was very rare: only 2.2% of all women included. Planned CS was performed in one third of women with well controlled VL near delivery, including 18% with no other indication than HIV infection.
Methods: All pregnancies of HIV1-infected women enrolled between 2005 and 2009 in the detailed component of the national French Perinatal Cohort (ANRS-CO1-EPF) were categorized into two groups according to maternal viral load near delivery: uncontrolled (>400copies/mL: N=254) and controlled (< 400copies/mL: N=2548).
Results: For women with uncontrolled viral load, the main mode of delivery was planned CS as recommended (49.6%). Nevertheless 24.8% of women delivered vaginally, much more frequently in premature than term deliveries (82.8% vs 18.4%, p< 0.01).
For women with controlled viral load, 48.0% delivered vaginally and 30.6% had a planned CS. In that group, vaginal delivery was associated with Sub-Saharan Africa origin, multiparity, characteristics of maternity and indicators of optimal follow up (HIV diagnosed before the last gestational trimester, undetectable VL < 50cp/ml near delivery). Previous caesarean was mentioned as only or associated indication for 41.9% of the planned CS with well controlled viral load. Other obstetrical or maternal indication in lack of repeat caesarean concerned 23.8% of them. HIV infection was the only indication reported for 18%.
Prolonged hospitalization and maternal post-partum complications were more frequent in case of caesarean than vaginal delivery (p< 0.01), with a higher proportion of prolonged hospitalisation in case of uncontrolled viral load.
Conclusion: Among women with VL >400 cp/mL, one quarter delivered vaginally, but, overall, this situation was very rare: only 2.2% of all women included. Planned CS was performed in one third of women with well controlled VL near delivery, including 18% with no other indication than HIV infection.