Efficacy and safety of caesarean delivery for prevention of mother-to-child transmission of HIV-1
RHL practical aspects by Limpongsanurak S
FIRST CONTACT (PRIMARY CARE LEVEL)
Owing to resource restriction in under-resourced settings and risk of complications of surgery, routine elective caesarean section delivery is not advisable at this level even if there is capacity to perform caesarean section. At this level caesarean section should be performed only for obstetric indications. To reduce the risk of perinatal HIV-1 transmission, zidovudine prophylaxis is recommended, unless the women are intolerant to zidovudine. Zidovudine should be given to all infants born from HIV 1-infected mothers.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Delivery by elective caesarean section can be offered at this level to prevent mother-to-child transmission of HIV-1 infection. This should be preceded by a complete laboratory investigation, which should include CD4 count. It is recommended also to measure the viral load if possible. Where feasible, it is recommended to give combination antiretroviral therapy to pregnant women antepartum, intrapartum, and postpartum. Elective caesarean section should be scheduled only at 38–39 weeks of gestation for women with plasma HIV-RNA levels above 1000 copies/ml or in women who are not receiving antiretroviral therapy.
AT HOME OR IN THE COMMUNITY
Following delivery, both mothers and infants should be followed up with regular health check-ups to monitor their progress.
This document should be cited as: Limpongsanurak S. Efficacy and safety of caesarean delivery for prevention of mother-to-child transmission of HIV-1: RHL practical aspects (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.