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Zentralbl Gynakol 2005; 127(4): 242-247
DOI: 10.1055/s-2005-836480
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Geburtshilfliches Management bei HIV-positiven Schwangeren: Ergebnisse einer retrospektiven Analyse an einem integrativen Zentrum

Management of HIV-positive Pregnancies - Results from a Retrospective StudyA. Ahr1 , C. Faul-Burbes1 , N. Haardt1 , R. Linde2 , A. Haberl3 , D. Bremerich4 , S. Kissler1 , R. Schloesser2 , M. Kaufmann1
  • 1Zentrum für Frauenheilkunde der J.W.G.-Universität Frankfurt/M.
  • 2Zentrum für Kinderheilkunde der J.W.G.-Universität Frankfurt/M.
  • 3Infektionsambulanz des Zentrums für Innere Medizin der J.W.G.-Universität Frankfurt/M.
  • 4Zentrum für Anästhesie, Intensivmedizin und Schmerztherapie der J.W.G.-Universität Frankfurt/M.
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Publication History

Publication Date:
22 July 2005 (online)

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Zusammenfassung

Fragestellung: Auswertung des geburtshilflichen Managements von HIV-positiven Schwangeren in Bezug zu prä-, peri- und postpartalen Komplikationen und der vertikalen Transmissionsrate. Patientinnen und Methoden: Retrospektive Untersuchung von 88 HIV-positiven Schwangerschaften, welche im Zeitraum 1.1.1997-31.12.2001 an der Universitäts-Frauenklinik Frankfurt entbunden wurden. Ergebnisse: HIV-positive Schwangere wiesen signifikant mehr präpartale Komplikationen auf als das Vergleichskollektiv. Es konnte keine Korrelation zwischen einer erniedrigten CD4-Zellzahl (< 200/µl) bzw. einer erhöhten Viruslast (> 10 000 HIV-Kopien/ml) und der Häufigkeit von transmissionsrelevanten Komplikationen nachgewiesen werden. Nahezu alle Schwangeren (85/88) erhielten eine antiretrovirale Therapie (ART). Die vertikale HIV-Transmissionsrate lag bei 3,4 % (3/89 Kindern, mit ART 2,5 % [2/86], ohne ART 33,3 % [1/3]). Schwangerschaften mit Komplikationen wiesen höhere Transmissionsraten auf (2/26 [7,7 %] vs. 1/61 [1,6 %]). Ebenso erhöhte sich die Transmissionsrate bei Kindern, welche ≤ 35. Schwangerschaftswoche entbunden wurden (5,3 % vs. 2,9 %). 98 % der Schwangeren (n = 86) wurden per Sectio caesarea entbunden (geplant: n = 71, vorzeitig: n = 15, spontan: n = 2). Die postpartale Komplikationsrate zwischen HIV-positiven und -negativen Schwangeren unterschied sich nicht. Kein Kind wurde gestillt. Schlussfolgerung: Durch die Betreuung dieser Risikoschwangerschaften in einem HIV-spezialisierten Zentrum und bei Beachtung der Behandlungsempfehlungen kann die vertikale Transmissionsrate deutlich minimiert werden.

Abstract

Objective: The management of HIV-positive pregnancies was investigated in conjunction to pre-, peri and postpartal complications and the HIV transmission rate. Patients and Methods: Retrospective study of 88 HIV-positive patients who were delivered at the Dept. of Obstetrics and Gynaecology during 1.1.1997-31.12.2001. Results: HIV-positive patients showed significantly more prepartal complications, compared to control group. Low CD4-cell count (≤ 200/µl) or high viral load (> 10 000 HIV-copies/ml) was not associated with increased risk for transmission relevant complications. The overall HIV-transmission rate was 3.4 % (3/89 newborns; with ART 2.5 % [2/85], without ART 33.3 % [1/3]). The transmission rate increased with complications during pregnancy (7.7 % [2/26] vs. 1.6 % [1/61]). Newborns delivered ≤ 35th week of gestation showed a transmission rate of 5.3 % compared to 2.9 % of newborns delivered after the 35th week of gestation. 98 % of the patients were delivered by cesarean section (primary: n = 71, prior: n = 15), spontaneously: n = 2). 97 % of patients (85/88) were treated with antiretroviral therapy (ART). No differences were found in the post-partal complication rate of HIV-positive to -negative patients. None of the newborns was breast feeded. Conclusions: Treatment of this risk-pregnancies in HIV experienced centers significantly reduces the risk of HIV transmission.

Schlüsselwörter

HIV - Schwangerschaft - vertikale Transmission - Komplikationen

Key words

HIV - pregnancy - vertical transmission - complications

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Priv. Doz. Dr. med. A. Ahr

Gynäkologische Praxis am Ziegelturm

Am Ziegelturm 4

63571 Gelnhausen

Phone: 00 49/60 51/44 34

Fax: 00 49/60 51/52 66

Email: Ahr@em.uni-frankfurt.de