Department of Infectious diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
PLoS One. 2018 Mar 22;13(3):e0194370. doi: 10.1371/journal.pone.0194370. eCollection 2018.
Vaginal delivery has been recommended for more than ten years for women living with HIV (WLWH) with good virological control. However, in Europe most WLWH still deliver by cesarean section (CS). Our aim was to assess the rate of vaginal delivery and the indications for CS in WLWH over 20 years in a setting of low overall CS rate.
This was a retrospective study of all WLWH delivering in Finland 1993-2013. We identified the women by combining national health registers and extracted data from patient files.
The study comprised 212 women with 290 deliveries. Over 35% of the women delivered several children during the study years. During 2000-2013, with consistent viral load monitoring, 80.0% showed HIV viral loads <50 copies/mL in the last measurement preceding the delivery. Altogether 74.5% of all WLWH delivered vaginally and the rate of both elective CS and emergency CS was 12.8% each. For most CSs (63.5%) the indication was obstetrical, for 28.4% it was avoiding HIV transmission and for 0.7% it was mother's request. In hospitals with less than ten HIV-related deliveries during the study period, the rate of elective CS was higher than in more experienced hospitals (22.7% versus 10.6% [p = 0.024]). No perinatal HIV transmissions occurred.
Most WLWH can achieve good virological control and deliver vaginally. This will help them to maintain their future child bearing potential and reduce CS-related morbidity.
对于病毒载量得到良好控制的 HIV 感染者（WLWH），十余年来，医学领域一直推荐其进行阴道分娩。然而，在欧洲，大多数 WLWH 仍选择剖宫产（CS）分娩。我们的目的是评估在 CS 总体比率较低的情况下，20 多年来 WLWH 阴道分娩的比率和 CS 的指征。
这是一项对芬兰 1993-2013 年所有 WLWH 分娩的回顾性研究。我们通过结合国家健康登记和从患者档案中提取数据来识别这些女性。
这项研究包括 212 名妇女的 290 次分娩。在研究期间，超过 35%的妇女生育了多个孩子。在 2000-2013 年期间，随着持续的病毒载量监测，80.0%的妇女在分娩前的最后一次测量中 HIV 病毒载量<50 拷贝/mL。共有 74.5%的 WLWH 经阴道分娩，选择性 CS 和紧急 CS 的比率分别为 12.8%。对于大多数 CS（63.5%），指征是产科原因，28.4%是为了避免 HIV 传播，0.7%是母亲的要求。在研究期间，每 10 次 HIV 相关分娩中少于 10 次的医院，选择性 CS 的比率高于经验丰富的医院（22.7%比 10.6%[p=0.024]）。没有发生围产期 HIV 传播。
大多数 WLWH 可以达到良好的病毒学控制并进行阴道分娩。这将有助于她们保持未来的生育能力，并减少与 CS 相关的发病率。
