Evaluation of perinatal and postnatal outcomes of delivery type, delivery period and follow-up labor in HIV positive pregnancies from the perspective of fetal infection

Abstract

Objective: Human immunodeficiency virus (HIV) was first described in 1981 in the world, and the first case in our country was seen in 1985. The total number of cases is 21.988 as of 30 June 2019, which was 3 in 1985. Considering the transmission routes of HIV positive cases in our country, the rate of transmission from mother to baby seems to be 1%, but it is likely that this ratio will be higher if 48.6% of all cases are not known. Material and Methods: In this study, perinatal histories and laboratory features of babies born from HIV-positive mothers are planned to be analyzed retrospectively. As far as possible information on HIV infection and the course of pregnancy has been obtained from the medical records and the perinatal history and laboratory features of HIV-infected mother’s babies who delivered between 2009 and 2019 at our hospital were analyzed retrospectively. Results: Fifteen infants’ (60% male, 40% female) mothers were diagnosed in 2 (13.3%) before pregnancy, 7 (46.7%) of the mothers during pregnancy, and 6 (40%) of the mothers during delivery. It was ascertained that eight mothers (53.3%) received antiretroviral treatment during pregnancy and 2 (13.3%) mothers delivered by normal spontaneous vaginal route. Zidovudine prophylaxis was started in one of the babies born with a normal spontaneous vaginal route, and the HIV virus load was still negative after eight weeks of prophylaxis and the prophylaxis was discontinued, the other baby was taken by the mother without permission. Premature membrane rupture was detected in three (20%) pregnant women, and the longest labor time was 16 hours. Eleven (73.3%) pregnant women received intravenous zidovudine therapy and 13 (86.6%) babies received antiretroviral prophylaxis. The viral load of the others was negative except one of the 11 babies whose HIV viral load was examined. The patient with a positive HIV viral load (300.000 copies/mL) was born by cesarean at 38 weeks of gestation and her mother was diagnosed during delivery and triple antiretroviral prophylaxis (zidovudine, lamivudine, nevirapine) was started on to baby. Conclusion: Although HIV prevalence is not high in Turkey, the number of cases has been increasing over the years. Perinatal transmission of the HIV virus from mother to baby can be reduced by measures to be taken before, during and after birth. In particular, it should be ensured that HIV infection is not diagnosed late or missed during pregnancy, and HIV-infected pregnant women should be followed up by centers which specialized in HIV.