Operative vaginal delivery and invasive procedures in pregnancy among women living with HIV

Abstract

Objectives To describe the use and outcomes of operative delivery and invasive procedures in pregnancy amongst women living with HIV. Study Design ConclusionsThis is the largest study to date to report on operative delivery in women living with HIV on cART, and provides an up-to-date picture of invasive procedures during pregnancy in this group. Findings from this comprehensive national study are reassuring but numbers are currently low; on-going monitoring is crucial as obstetric care of women with HIV becomes normalised.

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018

“…Limited data suggest that amniocentesis is safe in women on cART . There are minimal data on other forms of prenatal invasive testing.…”

“…The NSHPC recently reported data on operative vaginal deliveries in women in the cART era between 2008 and 2016; of 3023 vaginal deliveries, 251 infants were delivered with forceps or vacuum . Infection status was available for 222/233 infants who had reached 18 months of age: one infant was diagnosed with HIV, but timing of infection is unclear and there were other risk factors present.…”

Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality: An expert opinion

“…[18] There are very few data available on mother-to-child transmission (MTCT) of HIV with AVD. A large population-based surveillance study in the UK and Ireland (National Study of HIV in Pregnancy and Childhood) [19] has collected data on deliveries since 2008. Of the 9 072 live births reported, 251 were assisted vaginal deliveries.…”

Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda

“…(29) Furthermore, it is unlikely that second-stage CS provides a better protection for HIV transmission compared to vacuum extraction, especially considering the delay between the decision to perform a CS and actual birth. (28,29) Decision on mode of birth in HIV-positive women should be based on risks and bene ts, depending on the underlying risks associated with disease stage, antiretroviral treatment and local capacity to manage potential complications. (30) There were also suggestions to raise awareness about bene ts of vacuum extraction through presenting local outcomes in order to sensitize not only health workers, but also women.…”