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

[摘要] Objective. To evaluate the management and outcomes of aseries of human immunodeficiency virus-(HIV-) infected women whosepregnancies were complicated by preterm premature rupture ofmembranes (PPROM).Study design. We conducted aretrospective chart review of all women with confirmed HIVinfection who had a pregnancy complicated by PPROM remote fromterm. PPROM remote from term was defined as rupture of membranesprior to 32-week gestation. Collective cases from two centers(Hennepin County Medical Center and The University of Alabama atBirmingham) were reviewed and data on management and outcomes wereabstracted.Results. Of the HIV-positive women, weidentified 291 pregnancies having occurred in the study intervalfrom two institutions. Of these pregnancies, 7 (2.4%)developed PPROM remote from term with subsequent delivery from25- to 32-week gestation. Vertical HIV transmission was notedin 2 of 6 children whose long-term followup status was confirmed(33%) of these cases. However, both of these cases occurredin women with either no antepartum/intrapartum antiviral therapyor where only zidovudine monotherapy was used. Importantly, inspite of expectant management, no cases of vertical HIVtransmission occurred in women who were receiving either multidrugor highly active antiviral therapy (HAART) at the time of PPROMand who had a cesarean delivery in cases where the predeliveryviral load > 1000 copies/mL.Conclusion. Our limitedobservations raise the question as to whether in the current eraof multidrug therapy immediate delivery should be undertaken inHIV+ pregnancies complicated by PPROM at an early gestational age.This case series further suggests that in those pregnancies thatlend themselves to expectant management, such a strategy may beconsidered appropriate.

[学科分类] 妇产科学