Practising obstetrics and gynaecology in areas with a high prevalence of HIV infection
Verkuyl, D.A.
Lancet 346(8970): 293-296
1995
ISSN/ISBN: 0140-6736 PMID: 7630253 DOI: 10.1016/s0140-6736(95)92171-0Document Number: 291517
In Zimbabwe, there are about 120,000 pregnancies involving women infected with human immunodeficiency virus (HIV) each year--a finding that has major implications for the practice of gynecology and obstetrics in the country. For financial, cultural, and psychological reasons, HIV screening is not provided routinely to pregnant women in Africa. About 28% of infants of HIV-positive mothers are infected in utero (20% during labor) and an additional 14% are infected by breast feeding. To minimize vertical transmission of HIV, obstetricians are urged to avoid blood transfusions during delivery, clamp the umbilical cord as early as possible, use rubber cap vacuum extractors that prevent head abrasions, modify cesarean section techniques to reduce contact with maternal blood, and wipe rather than suction blood from the newborn's face. After delivery, HIV-infected women are at increased risk of puerperal sepsis, massive condylomata acuminata, fever, wasting, and mortality. No guidelines have been developed for the feeding of infants of HIV-infected mothers since formula is prohibitively expensive. Most African couples resist HIV testing. However, in cases where one or both partners are known to be infected, condoms, long-acting injectable contraception, or sterilization should be considered.