P29. Mode of delivery among HIV-infected women in Helsinki University Hospital 2006-2013

Inka Aho1, Marja Kaijomaa2, Pia Kivelä1, Jussi Sutinen1, Oskari Heikinheimo2
Affiliates: Infectious diseases1, Obstetrics and gynecology2, University of Helsinki and Helsinki University Hospital, Finland

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Antiretroviral therapy (ART) during pregnancy, appropriate obstetric care, no breastfeeding and ART prophylaxis to infants are the cornerstones of minimizing the vertical transmission of HIV. Elective Caesarean section (CS) has been recommended as a preferable mode of delivery by several guidelines until recent years. Our hospital has aimed towards vaginal delivery from the beginning of the HIV-epidemic.

In this retrospective study we included all HIV-infected women who had had at least one delivery in the Helsinki University Hospital during 2006-2013.

Altogether 115 children were born to 89 women. No mother-to-child transmissions occurred.
Twenty-nine percent of the women were of Finnish origin, 41 % originated from Sub-Saharan Africa, 11 % from Far-East Asia and 18 % from former Soviet Union area. Nine percent had IV drug use as a mode of transmission. Twenty-eight percent of women were diagnosed with HIV during pregnancy.
Fifty-five percent of the women had viral load <200 copies/ml at the beginning of the pregnancy and 94% before the delivery.
During the study period 88 (76.5 %) deliveries were vaginal and 27 (23.5 %) were Caesarean sections. Of all deliveries 9 (7.8 %) were elective CS.
Only 6 CS (5.2 % of all deliveries) were performed due to HIV-indication: 2 mothers refused ART throughout the pregnancy, 2 were immigrants being diagnosed with HIV only 1-2 weeks before delivery, 1 mother arrived to Finland in labour with no confirmed medical history of ART and 1 arrived in labour a few days before scheduled CS. A high hepatitis C viral load was indication for one elective CS.
Four elective CS were performed because of obstetrical indications, two for breech presentation and two for previous CS. Sixteen attempted vaginal deliveries turned to CS for obstetrical reasons, mainly failure to progress or suspected fetal asphyxia. No CSs were performed for maternal request without medical indication.

No HIV-positive children were born to HIV-positive mothers in Helsinki during 2006-2013. The rate of Caesarean section was similar to the overall rate of CS at our institution. CSs were mainly performed because of obstetrical reasons.

The policy of vaginal delivery appears safe and justified in women with well controlled HIV infection.

(This data has partly been presented at the 40th Nordic Congress of Obstetrics and Gynecology (NFOG) in June 2016 in Helsinki Finland)