THE MANAGEMENT OF PREGNANCY AND DELIVERY IN HIV-INFECTED WOMEN IN EUROPE

In view of the increasing heterosexual spread of HIV and reports of interventions which reduce the rate of mother to child transmission, a postal questionnaire survey was performed to determine the strategies for the management of pregnancy and delivery in HIV-infected women in 56 obstetric centres in 21 European countries. A response rate of 96% was achieved. Antenatal testing for HIV infection was routinely offered in 96% of centres. Pre- and post-test counselling was available in most centres and was mainly provided by the obstetrician; only 12 centres had trained counsellors. Compared to uninfected women, infected women made more antenatal visits in 36% of centres and had more screening tests in 30% of centres. Some delivery procedures (e.g. use of scalp electrodes) were less common in infected than in uninfected women. Nearly half the centres prescribe Zidovudine to infected women; most prescribed it specifically to reduce HIV vertical transmission. Disinfection of the birth canal and elective caesarean sections for infected women were routinely performed in 22% and 18% of centres, respectively. The survey revealed different approaches to the management of infected pregnant women both between and within countries, which may partly be due to limited knowledge of what constitutes optimal management. especially in relation to interventions to reduce vertical transmission. Randomised control trials are required to establish the most effective intervention.