Background In the UK, 2.2 per 1000 women giving birth have HIV.1 Routine antenatal screening and BHIVA guidelines1 recommending multidisciplinary input have reduced mother-to-child HIV transmission (MTCT). Antiretroviral therapy (ART) is recommended to prevent MTCT and for maternal welfare. In those with a low viral load, vaginal delivery is safe.1 However, there is growing evidence of an association with idiopathic preterm delivery2 and increasing emergency CS rates.1
Objective To analyse the obstetric outcomes in this population group.
Method A 9-year (2005–2013) prospective cohort study of the HIV-positive pregnant women delivering at West Middlesex University Hospital.
Results In total, 101 pregnancies, 93 of which were ongoing with 96 live births (3 sets of twins). The median age of the population was 29 (r16–44). Birth plans were conceived for 85 (91%) women. Antenatally, 4 patients had GDM, 1 had Obstetric Cholestasis, 1 gestational thrombocytopaenia and 1 PET. Mean gestational age of delivery was 38 ± 2 (SD) weeks, 13 (14%) delivered preterm (<37 weeks, r31–36) with abruption in 2, PROM in 1, appendicitis in 1 and idiopathic in 9 (69%). Vaginal delivery was planned for 45 (48%) women; 17 (18%) needed emergency CS resulting in 3 postpartum haemorrhages and 1 neonatal seizure. No vertical transmission was noted at follow up to 18 months.
Discussion Multidisciplinary input into the care of HIV-positive pregnancies helps achieve good outcomes in the majority with nearly half achieving vaginal delivery and no vertical transmissions. We confirm the increased incidence of idiopathic preterm delivery needing further exploration.
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