[Management of pregnant women infected with HIV at Bichat Hospital between 1990 and 1998: analysis of 202 pregnancies]

Abstract

Objective: To describe medical and obstetrical prenatal care of pregnant women infected by HIV-1 emphasizing the role of cesarean section.

Design: A retrospective study of 202 pregnancies followed between 1990 and 1998 in a french hospital in Paris.

Results: 56.9% of the women were born in subsaharian Africa; 80.2% were infected by sexual intercourse and the seropositivity was discovered during the pregnancy in 51% of the cases. Viral coinfections by hepatitis B virus, hepatitis C virus and Human papillomavirus were found respectively in 14.7%, 16.5% and 13% of the pregnancies. Prematurity occurred in 15% of the deliveries. Efficacy of antiretroviral therapy was confirmed in this study: 5.7% of the children were infected despite the antiretrovial treatment versus 19.3% without treatment (p < 0.03). Prophylactic cesarean section was proposed to the patients since 1994; the morbidity of cesarean was 8.8% (69 cesarean sections).

Conclusion: The policy of the association of prophylactic cesarean section and monotherapy by Zidovudine is validated by recent studies. The extension of prophylatic cesarean section to all the pregnant women infected by HIV is proposed. However the evaluation of the morbidity of the cesarean section in HIV infected women needs a prospective case-control study.