HIV/AIDS: ACOG Recommends Caesareans for HIV+ Mothers

      Following published findings that show vertical HIV transmission appears to occur during a pregnant woman's labor and vaginal delivery, the American College of Obstetricians and Gynecologists has recommended that all HIV-positive pregnant women be offered cesarean delivery at the 38th week of pregnancy. Combining cesarean delivery with zidovudine treatment reduces the chance of transmission to 2%. In contrast, HIV-positive women who delivery vaginally and do not take ZDV have a 25% risk of transmitting the disease to their newborns, while those who deliver vaginally but take ZDV, along with their newborns, have a 5% to 8% chance of transmitting the disease. The HIV infection rate among U.S. births has declined steadily due to increased testing and the use of ZDV therapy for mothers and newborns. According to CDC data, approximately 6,500 HIV-positive women give birth each year. ACOG notes, however, that medical personnel must respect a woman's right to choose whether to have a cesarean delivery, as it entails an increased risk of morbidity. ACOG recommended that doctors discuss the option with HIV-positive, pregnant women as early as possible (ACOG release, 7/31).