Case 3: Perinatal HIV Transmission and Route of Delivery

Question | Discussion | References | CME Credit

You answered:

	Perform an emergent amniocentesis to determine fetal lung maturity, followed by induction of labor if the results are positive.

This answer is incorrect. For HIV-infected mothers, the American College of Obstetrics and Gynecology (ACOG) recommends using clinical estimates of gestational age and to avoid amniocentesis whenever possible. In addition, in this case, a scheduled cesarean section delivery at 38 weeks completed gestation would be recommended, since this HIV-infected mother has a viral load greater than 1,000 copies/ml.

Choose another answer:

	Advise that vaginal delivery would be appropriate after 38 completed weeks of gestation, since cesarean section does not reduce the risk of HIV transmission if the maternal HIV RNA level is less than 50,000 copies/ml.
	Continue to counsel her about the efficacy of HAART in reducing mother-to-child HIV transmission, arrange for an elective cesarean section delivery at 38 completed weeks of gestation, and give intravenous zidovudine starting 3 hours prior to the cesarean section.
	Continue to counsel her about the efficacy of HAART in reducing mother-to-child HIV transmission, schedule a cesarean section delivery at 40 completed weeks of gestation, and give intravenous zidovudine starting 3 hours prior to the cesarean section.

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