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Case 3: Perinatal HIV Transmission and Route of Delivery

You answered:

B 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.

This answer is incorrect. Available data suggest that cesarean section results in lower rate of maternal-to-child HIV transmission in women who have a viral load greater than 1,000 copies/ml at (or near) delivery if the cesarean occurs prior to the onset of labor and prior to rupture of membranes. Although she might have partial resistance to zidovudine, she should receive intravenous zidovudine immediately prior to the delivery.

Choose another answer:

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