Delivery

What Works

Promising Strategies

1.: The use of antiretroviral drug regimens for either treatment of the mother’s health or prophylaxis to prevent mother-to-child transmission of HIV may reduce the advantage of cesarean over vaginal deliveries.

1. The use of antiretroviral drug regimens for either treatment of the mother’s health or prophylaxis to prevent mother-to-child transmission of HIV may reduce the advantage of cesarean over vaginal deliveries.

A study in Nigeria of 1,138 babies exposed to HIV found that with HAART, PMTCT rates following C-section (3.6%) was not different from vaginal delivery (3.53%).

Gray IV Sagay et al., 2008 Nigeria, cesarean section, HAART, PMTCT, delivery

Sagay, A., J. Musa, S. Ogwuch, E. Ejeliogu, G. Imade, C. Ekwempu, S. Kapiga, J. Sankale, J. Idoko and P. Kanki. 2008. “Outcome of Interventions to Prevent Mother-to-child Transmission of HIV-1 in Jose, Nothern Nigeria.” Abstract MOPE0526. XVII Internaitonal AIDS Conference. Mexico City, Mexico. August 3-8.

Because the risk of perinatal transmission of HIV is directly proportional to maternal viral loads, for women who have either very low or undetectable viral loads, there may be no additional benefit to cesarean section delivery. “For those [women] on highly active antiretroviral therapy who have undetectable or low viral loads, the added benefit of cesarean delivery is not established and is probably negligible”.

Gray V Sharma and Spearman, 2008: 414 cesarean section, PMTCT, delivery HAART

Sharma, D. and P. Spearman. 2008. “The Impact of Cesarean Delivery on Transmission of Infectious Agents to the Neonate.” Clinical Perinatology 35: 407-420.