[O6] Pregnancy and mode of delivery in HIV-positive women at two London centres: have the BHIVA pregnancy guidelines led to an increase in vaginal deliveries in women with undetectable viral load?

13th Annual Conference of the British HIV Association

29 March–1 April 2007, Brighton, UK

PREGNANCY AND MODE OF DELIVERY IN HIV-POSITIVE WOMEN AT TWO LONDON CENTRES: HAVE THE BHIVA PREGNANCY GUIDELINES LED TO AN INCREASE IN VAGINAL DELIVERIES IN WOMEN WITH UNDETECTABLE VIRAL LOAD?

HIV Med 2007; 8(Suppl. 1):2 (abstract no. O6)

Sherie Roedling¹, Claire Townsend² and Eva Jungmann¹
¹The Mortimer Market Centre, Camden PCT, London, UK, ²UCL Institute of Child Health, London, UK

AIMS: In March 2005 BHIVA guidelines on management of pregnancy in women with HIV were changed from advising elective caesarean section (CS) to all women to offering vaginal delivery (VD) to mothers on triple antiretrovirals (ARVs) if viral load (VL) undetectable. We aimed to assess whether this has influenced the number of VDs in our centres.

METHODS: Pregnancies were identified from clinic database and from data submitted to the National Study of HIV in Pregnancy and Childhood since 1989. Data on pregnancy outcome, ARV treatment of mother, CD4 and VL, and mode of delivery (MOD) were collected. Eligibility for VD (undetectable VL) was compared with actual mode of delivery. Data were analysed using EpiInfo.

RESULTS: Of data available for 262 pregnancies, 208 continued to term. Sixty-one (29%) were taking ARV treatment at conception and 170 (82%) received ARVs during pregnancy. Mean CD4 was 460 × 10⁶/L. Seven women were diagnosed post-partum. Eighteen have not delivered as yet. MOD (n=183), was VD in 30 (16%), elective CS in 117 (63%), emergency CS in 24 (13.1%), unknown in 19. Overall, 66 (36%) women were eligible for VD by VL criteria. Prior to the updated BHIVA guidelines 53 (34%) women would have been eligible for VD, of whom four (7%) had VD, 36 (71%) elective CS and 11 (20%) emergency CS. Publication of the new BHIVA guidelines significantly changed the MOD. Of 13 (48%) women eligible for VD, five (38%) had VD, two (15%) elective CS and six (46%) emergency CS (P<0.05).

DISCUSSION: Improved ARV treatment and VL suppression in pregnancy means more women will be eligible for VD, with service planning implications. Close liaison between HIV team, obstetricians, midwives and paediatricians is vital.

2007-03-29
O6

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