Perinatal HIV-1 Transmission

Abstract
THE IMPORTANCE of labor and delivery in mother-to-child transmission of human immunodeficiency virus 1 (HIV-1) has been suspected for years. A large body of data indicates that transmission occurs predominantly late in pregnancy and intrapartum.1-4 However, the role of obstetrical management remains unclear. An increased risk of transmission was observed in several studies in association with rupture of membranes before the onset of labor5 or more than 4 hours before delivery,6 and in a few studies with events such as hemorrhage and bacterial infection.5,7,8 Conversely, conditions of delivery itself, such as length of labor, instrumental delivery, or episiotomy, had little relation to transmission.5,6,9 The impact of mode of delivery is still controversial.10 Transmission risk was decreased following cesarean delivery in some studies,11-13 but not in others.5,6,14-17