There is more to pregnancy and labour in the HIV positive than discusssed
This article is very much from a centralised institute in South
Africa and gives too little guidance to a district doctor or even a doctor
in a central hospital in say Uganda, Tanzania or Zimbabwe.
The management of labour in (possible) HIV infected women has been
discussed earlier and in more detail (1). I miss for example whether the
cord should be clamped as soon as possible (presumably the placental
barrier for HIV becomes more incompetent while the placenta is
disconnecting) and a warning not to suck out the baby routinely because
there is a grave risk of pushing the mothers blood/secretions up the
baby’s fragile internal nose and mouth. Should there be a high threshold
for repairing 2e degree tears because repairs in that area often result in
finger pricking? What will be the consequences for the woman of having an
unsutured tear? Should a cetrimide cream be used on the vacuum cup to
prevent vertical transmission through abrasions? This vertical
transmission risk serves presently in many large hospitals in Africa as an
excuse for not performing instrumental deliveries anymore. What do the
authors think?
A discussion about the ethics of offering the mother a tubal occlusion in
combination with an (elective) caesarean section in the HIV infected would
also have helped those who actually see the women(2) and the HIV infected
babies and the orphans. It should have been mentioned that discussing and
recording her future reproductive plans during the antenatal period is as
mandatory as reviewing her medication use, if any. The shortening of the
breast feeding period also has obvious fertility implications.
(1) Verkuyl DAA. Practising obstetrics and gynaecology in areas with
a high prevalence of HIV infection. Lancet 1995; 346:293-6.
(2) Verkuyl DAA Sterilisation during unplanned caesarean sections for
women likely to have a completed family – should they be offered?
Experience in a country with limited health resources Brit. J. Obs &
Gyn 2002; 109:900-904.
Rapid Response:
There is more to pregnancy and labour in the HIV positive than discusssed
This article is very much from a centralised institute in South
Africa and gives too little guidance to a district doctor or even a doctor
in a central hospital in say Uganda, Tanzania or Zimbabwe.
The management of labour in (possible) HIV infected women has been
discussed earlier and in more detail (1). I miss for example whether the
cord should be clamped as soon as possible (presumably the placental
barrier for HIV becomes more incompetent while the placenta is
disconnecting) and a warning not to suck out the baby routinely because
there is a grave risk of pushing the mothers blood/secretions up the
baby’s fragile internal nose and mouth. Should there be a high threshold
for repairing 2e degree tears because repairs in that area often result in
finger pricking? What will be the consequences for the woman of having an
unsutured tear? Should a cetrimide cream be used on the vacuum cup to
prevent vertical transmission through abrasions? This vertical
transmission risk serves presently in many large hospitals in Africa as an
excuse for not performing instrumental deliveries anymore. What do the
authors think?
A discussion about the ethics of offering the mother a tubal occlusion in
combination with an (elective) caesarean section in the HIV infected would
also have helped those who actually see the women(2) and the HIV infected
babies and the orphans. It should have been mentioned that discussing and
recording her future reproductive plans during the antenatal period is as
mandatory as reviewing her medication use, if any. The shortening of the
breast feeding period also has obvious fertility implications.
(1) Verkuyl DAA. Practising obstetrics and gynaecology in areas with
a high prevalence of HIV infection. Lancet 1995; 346:293-6.
(2) Verkuyl DAA Sterilisation during unplanned caesarean sections for
women likely to have a completed family – should they be offered?
Experience in a country with limited health resources Brit. J. Obs &
Gyn 2002; 109:900-904.
Competing interests:
none
Competing interests: No competing interests