Case 3: Perinatal HIV Transmission and Route of Delivery

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You answered:

	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.

This answer is incorrect. In this situation, with the mother having a viral load greater than 1,000 copies/ml, a scheduled elective cesarean section delivery would be appropriate. Scheduling delivery at 40 completed weeks of gestation would not be appropriate, since there would be a substantially higher risk that she would enter labor or rupture her membranes after 38 completed weeks of gestation. The benefit of cesarean is markedly reduced if the woman presents more than 4 hours after rupture of membranes.

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

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