Cesarean section and perinatal transmission.

Researchers believe most perinatal transmission of HIV occurs during labor. Three studies now suggest that cesarean sections (C-sections) before labor may reduce perinatal transmission risk. The European Mode of Delivery Collaboration and a study by Mandelbrot showed a dramatic decrease in the number of perinatal transmssions when elective C-sections were performed with the use of AZT therapy. Another analysis found that C-sections were effective in reducing the rate of transmission regardless of antiviral treatment. Although these results are positive, there was no evaluation of women on other antiretroviral therapy such as HAART. Additionally, viral load measurements were not reported. These factors may also influence transmission rate. Complications of C-section, including increased morbidity, is also a consideration discussed in the studies. Elective C-sections to reduce transmission cannot be recommended to all pregnant women at this time. Current standards of lowering viral load with antiretroviral regimens, and monitoring CD4 counts and HIV RNA should be employed, along with a discussion of Cesarean delivery.