2008 - 2012年英国牛津感染艾滋病毒女性的妊娠管理与结局

Management and outcomes of pregnancies among women with HIV in Oxford, UK, in 2008-2012.

作者信息

Montgomery-Taylor Sarah, Hemelaar Joris

机构信息

Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.

Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.

出版信息

Int J Gynaecol Obstet. 2015 Jul;130(1):59-63. doi: 10.1016/j.ijgo.2015.02.019. Epub 2015 Apr 11.

DOI:10.1016/j.ijgo.2015.02.019

PMID:25912413

Abstract

OBJECTIVE

To evaluate the management and outcomes of pregnancies among women with HIV infection.

METHODS

A retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008-2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management.

RESULTS

Overall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was diagnosed during pregnancy for 32% (19/60); 71% (12/17) were diagnosed after the first trimester. At booking, 47% of women (28/60) were not on treatment, all but one of whom commenced treatment, either for maternal reasons (CD4 count <350 cells per mm(3); 48% [13/27]) or prevention of mother-to-child-transmission (52% [14/27]). Viral load was high (>50 copies per mL) at delivery for 13% of women (8/61). Delivery was by cesarean for 74% [45/61]. One neonate was diagnosed with HIV infection. There were 6 (10%) preterm births, 9 (15%) cases of low birth weight, 11 (18%) small-for-gestational-age neonates, and 1 (2%) stillbirth.

CONCLUSION

Better pregnancy planning, earlier booking and HIV diagnosis, and optimal antiretroviral treatment should increase the proportion of women with a low viral load (<50 copies per mL) at delivery, lead to more vaginal deliveries, and further reduce mother-to-child transmission of HIV.

摘要

目的

评估感染人类免疫缺陷病毒（HIV）的女性妊娠的管理情况及结局。

方法

对2008年至2012年在英国某一中心分娩的HIV感染孕妇进行回顾性队列研究。查阅病历并提取有关产科和病毒学管理的详细信息。

结果

总体纳入61例妊娠；43%（26/60）为意外妊娠，39%（22/57）登记建档较晚。32%（19/60）的孕妇在孕期被诊断出HIV感染；其中71%（12/17）在孕早期后被诊断。登记建档时，47%的女性（28/60）未接受治疗，除1人外其余均开始治疗，原因要么是出于母亲自身因素（CD4细胞计数<350个/mm³；48%[13/27]），要么是为了预防母婴传播（52%[14/27]）。13%的女性（8/61）在分娩时病毒载量较高（>50拷贝/mL）。74%（45/61）的产妇通过剖宫产分娩。1例新生儿被诊断为HIV感染。有6例（10%）早产，9例（15%）低出生体重，11例（18%）小于胎龄儿，1例（2%）死产。