Course of labour in pregnant HIV-positive women with no contraindication for vaginal delivery
Polly Clayden, HIV i-Base
A French study found that the course of labour in HIV-positive women receiving ART with no contraindication (neither obstetrical nor virological) for vaginal delivery was similar to that of HIV-negative women.
This was a case-control study conducted between January 2000 and December 2005 in a single centre. Cases were matched with controls for parity, previous cesarean delivery and geographical origin.
The investigators reported no difference in the course of labour or the foetal tolerance of labor among the146 cases included in the analysis and matched with HIV-negative controls.
There was no difference in Caesarean delivery and assisted vaginal delivery rates were not different between the HIV-positive and negative women. The rate of episiotomy was significantly lower in HIV-positive women in this analysis (29.6% vs. 45.6%, p= 0.01) with no difference in the mean neonatal weight or the perineal laceration rate (simple or complex). They also found no difference in neonatal outcome.
In the HIV-positive group there were no cases of mother-to-child transmission.
Post-partum morbidity was similar between the groups. But the investigators noted that in HIV-positive women post-partum morbidity was significantly higher in women with CD4 count <200 cells/mm3 to >200 cells/mm3 (22.2% vs. 3.2%, p=0.007).
Azria E, Kahn A, Schmitz T et al. Course of labour in HIV infected pregnant women with no contraindication for vaginal delivery. 48th ICAAC, 25-28 October 2008. Washington. Abstract H-454.