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Mother-son HIV transmisión (vertical transmisión) depends on maternal, virological, immunological and fetal factores. This vertical transmisión may apeen during pregnacy, birth or breast feeding, but 70% of transmisión occurs during labor and delivery. Ninety percent of child infections worldwide are due to perinatal transmissin, as are virtually all new cases.
A large scale, multicentric study showed that AZT, administered between weeks 14 and 34 of gestation may significantly reduce the mother-son HIV transmission rate in women with a CD-4 count greater than 200/mm³ which have not previously received the drug. Transmission was 25.5% in 183 children whose mothers received a placebo compared to 8.3% in 180 children whose mothers received AZT (p=0.00006). The drug's toxicity was minimal. Major and minor malformations were similar in both groups and only a slight and transitory anemia was most commonly found in newborns exposed to AZT. On the other hand, there are highly significant findings which confirm that an elective cesarean reduces the risk of vertical transmission.
With our current knowledge we may define birth and delivery practices in the following matter:
Patient with or without AZT
1. Perform elective cesarean.
2. If labor begins spontaneously, vaginal delivery should be allowed unless obstetric indicators suggest an abdominal approach. An emergency cesarean should be avoided and should only be performed if the product is in danger and delivery occurs more than four hours after this tears.
