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Infectious Diseases in Obstetrics and Gynecology
Volume 2006 (2006), Article ID 53234, 7 pages
http://dx.doi.org/10.1155/IDOG/2006/53234
Clinical Study

Preterm Premature Rupture of Membranes in Human Immunodeficiency Virus-Infected Women: A Novel Case Series

1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, The University of Utah Health Sciences, 30 North 1900 East, SOM 2B200, Salt Lake City, UT 84132-2209, USA
2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hennepin County Medical Center, Minneapolis, MN 55415, USA
3Center for Research in Women's Health, The University of Alabama at Birmingham, Birmingham, AL 35294, USA

Received 24 November 2005; Accepted 12 January 2006

Copyright © 2006 Kjersti M. Aagaard-Tillery et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To evaluate the management and outcomes of a series of human immunodeficiency virus-(HIV-) infected women whose pregnancies were complicated by preterm premature rupture of membranes (PPROM). Study design. We conducted a retrospective chart review of all women with confirmed HIV infection who had a pregnancy complicated by PPROM remote from term. PPROM remote from term was defined as rupture of membranes prior to 32-week gestation. Collective cases from two centers (Hennepin County Medical Center and The University of Alabama at Birmingham) were reviewed and data on management and outcomes were abstracted. Results. Of the HIV-positive women, we identified 291 pregnancies having occurred in the study interval from two institutions. Of these pregnancies, 7 (2.4%) developed PPROM remote from term with subsequent delivery from 25- to 32-week gestation. Vertical HIV transmission was noted in 2 of 6 children whose long-term followup status was confirmed (33%) of these cases. However, both of these cases occurred in women with either no antepartum/intrapartum antiviral therapy or where only zidovudine monotherapy was used. Importantly, in spite of expectant management, no cases of vertical HIV transmission occurred in women who were receiving either multidrug or highly active antiviral therapy (HAART) at the time of PPROM and who had a cesarean delivery in cases where the predelivery viral load > 1000 copies/mL. Conclusion. Our limited observations raise the question as to whether in the current era of multidrug therapy immediate delivery should be undertaken in HIV+ pregnancies complicated by PPROM at an early gestational age. This case series further suggests that in those pregnancies that lend themselves to expectant management, such a strategy may be considered appropriate.