Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA.
Infect Dis Obstet Gynecol. 2020 May 7;2020:8196342. doi: 10.1155/2020/8196342. eCollection 2020.
The CDC and ACOG have issued guidelines for HIV screening in pregnancy for patients living in areas with high prevalence of HIV in order to minimize perinatal vertical transmission. There is a lack of data examining providers' compliance with these guidelines in at-risk patient populations in the United States.
To evaluate if HIV screening in pregnant women was performed according to guidelines at a large, urban, tertiary care medical center in South Florida. . A retrospective review was performed on 1270 prenatal and intrapartum records from women who delivered a live infant in 2015 at a single institution. Demographic and outcome data were chart abstracted and analyzed using arithmetic means and standard deviations.
Of the 1270 patients who met inclusion criteria, 1090 patients initiated prenatal care in the first or second trimester and delivered in the third trimester. 1000 (91.7%) patients were screened in the first or second trimester; however, only 822 (82.2%) of these were retested in the third trimester during prenatal care. Among the 178 patients lacking a third trimester test, 159 (89.3%) received rapid HIV testing upon admission for delivery. Of the 1090 patients who initiated prenatal care in the first or second trimester and delivered in the third trimester, 982 (90.1%) were screened in accordance with recommended guidelines. Of the 1270 patients initiating care in any trimester, 24 (1.9%) had no documented prenatal HIV test during prenatal care, however 22 (91.7%) had a rapid HIV test on admission for delivery. Two (0.16%) patients were not tested prenatally or prior to delivery.
Despite 99.8% of women having at least one HIV screening test during pregnancy, there is room for improvement in routine prenatal screening in both early pregnancy and third trimester prior to onset of labor in this high-risk population.
为了尽量减少围产期垂直传播，疾病预防控制中心和美国妇产科医师学会发布了针对高 HIV 流行地区妊娠患者的 HIV 筛查指南。目前，美国尚缺乏高危患者人群中评估医疗服务提供者遵循这些指南情况的数据。
评估在南佛罗里达州一家大型城市三级保健医疗中心，HIV 筛查在孕妇中的实施情况是否符合指南建议。
对在单一机构于 2015 年分娩活婴的 1270 例孕妇产前和产时记录进行回顾性研究。通过图表提取人口统计学和结局数据，采用算术平均值和标准差进行分析。
在符合纳入标准的 1270 例患者中，有 1090 例在孕早期或孕中期开始产前护理，并在孕晚期分娩。1000 例（91.7%）患者在孕早期或孕中期接受了筛查；然而，仅有 822 例（82.2%）在孕晚期产前护理期间接受了重复筛查。在缺乏第三次筛查的 178 例患者中，159 例（89.3%）在入院分娩时接受了快速 HIV 检测。在 1090 例于孕早期或孕中期开始产前护理并在孕晚期分娩的患者中，982 例（90.1%）按照推荐的指南接受了筛查。在所有开始于任意孕期的 1270 例患者中，有 24 例（1.9%）在产前护理期间没有记录 HIV 筛查，然而 22 例（91.7%）在入院分娩时接受了快速 HIV 检测。有 2 例（0.16%）患者在产前或分娩前未接受检测。
尽管 99.8%的孕妇在怀孕期间至少接受了一次 HIV 筛查，但在该高危人群中，在孕早期和临产开始前的孕晚期，常规产前筛查在早期妊娠和第三孕期仍有改进的空间。
