Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000

被引:27
作者
Dominguez, KL
Lindegren, ML
d'Almada, PJ
Peters, VB
Frederick, T
Rakusan, TA
Ortiz, DR
Hsu, HW
Melville, SK
Sadek, R
Fowler, MG
机构
[1] Ctr Dis Control & Prevent, Div HIV AIDS Prevent, Atlanta, GA 30333 USA
[2] New York City Dept Hlth, New York, NY 10013 USA
[3] Los Angeles Cty Dept Hlth Serv, Pediat AIDS Surveillance Study, Los Angeles, CA USA
[4] Childrens Natl Med Ctr, Washington, DC 20010 USA
[5] Puerto Rico Dept Hlth, AIDS Surveillance Program, Rio Piedras, PR USA
[6] State Labs Inst, Pediat AIDS Surveillance Project, Jamaica Plain, MA USA
[7] Texas Dept Hlth, Bur HIV & STD Prevent, Austin, TX 78756 USA
关键词
cesarean section; perinatal HIV transmission; mode of delivery;
D O I
10.1097/00126334-200306010-00019
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section). Objective: The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States. Design: A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AlDS Reporting System (HARS) (n 8,306) was conducted. Setting/Patients: All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled. Results: The proportion of deliveries by C-section was steady at about 20% from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44% in the PSD study and to nearly 50% in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1.43). Conclusions: The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.
引用
收藏
页码:232 / 238
页数:7
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