A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding veical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the veical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. This of the following represents the approximate risk of veical transmission (from the mother to the fetus) for this patient?
Studies have demonstrated that in the absence of maternal treatment with antiretroviral therapy or scheduled cesarean delivery, the rate of veical transmission is approximately 25%. Thus, all pregnant women should be offered HIV testing to identify those patients who are infected so that they may receive antiretroviral therapy and be offered scheduled cesarean delivery to decrease the rate of veical transmission. 2% (choice A) represents the approximate rate of veical transmission in women who receive antiretroviral therapy during the pregnancy and a scheduled cesarean delivery (i.e., a cesarean delivery prior to the onset of labor or rupture of membranes.) 8% (choice B) represents the approximate rate of veical transmission when women are treated with antiretroviral therapy during pregnancy and the neonate is treated postpaum. This rate was identified in the landmark study from the Pediatric AIDS Clinical Trials Group 076 study. This study showed that antepaum, intrapaum, and postpaum zidovudine (ZDV) use would reduce the veical transmission rate from 25% to 8%.
2%
8%
25%
50%