Background and methods: The paper reviews HIV infection in pregnancy. We have mainly used PubMed for literature searches with focus on risk factors for vertical infection and measures to prevent mother-to-child transmission.
Results: The risk of vertical HIV-transmission is greatest when the mother has high levels of viraemia. Antiviral treatment decreases the fetal risk. When the viral load is low, i.e. HIV-RNA below 1000 copies/ml, the risk of infection of the fetus is small; individually adapted antiviral treatment is indicated to obtain this goal. Increased risk of infection of the fetus may occur as a result of vaginal bleeding, amniocentesis, vaginal delivery, the use of scalp electrodes and fetal scalp pH measurement. The use of vacuum extraction and forceps delivery should be avoided if possible. An important factor associated with increased fetal risk is long lasting rupture of the membranes (> 4 hours).
Interpretation: Elective delivery by Caesarean section at 38th week, before labour and rupture of the membranes, is advocated. A Caesarean section may, however, cause complications, and vaginal delivery at term may be considered when the viraemia is low (HIV-RNA < 1000 copies/ml). Amniotomy and long-standing rupture of the membranes should be avoided, as should breastfeeding.