oa South African Family Practice - Is there still a role for Caesarean section in preventing vertical HIV transmission in the era of highly active antiretroviral therapy? : review article



Human immunodeficiency virus (HIV) may be transmitted from an infected mother to her child during pregnancy, delivery or breastfeeding. Without any intervention, transmission rates may range from 15-45%. However, this can be reduced to < 5% with effective drug therapy. A scheduled Caesarean section that is performed before the onset of labour or the rupture of membranes has been shown to reduce the intrapartum risk in a meta-analysis of earlier studies. The review further concluded that the benefit of performing an elective Caesarean section outweighed the risk of postpartum morbidity in HIV-infected women. However, balancing the risk to benefit ratio is influenced by the underlying rate of mother-to-child transmission (MTCT) in an individual patient.

Caesarean section, while initially shown to reduce the MTCT risk, is itself associated with significant morbidity to the mother. Pregnancy-related sepsis is among the leading causes of maternal deaths, particularly in women who deliver by Caesarean section.


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