Is the risk of perinatal transmission of human immunodeficiency virus increased by the intrapartum use of spiral electrodes or fetal scalp pH sampling?

OBJECTIVE: Our aim was to determine whether the intrapartum use of fetal scalp electrodes or fetal scalp pH sampling increases the rate of perinatal transmission of human immunodeficiency virus. STUDY DESIGN: The rate of perinatal transmission of human immunodeficiency virus in 31 monitored pregnancies was determined, and those pregnancies were compared with a control group of 117 pregnancies. RESULTS: The monitored group was comparable to the control group with respect to maternal age, race, human immunodeficiency virus risk behavior, CD4+ cell count, p24 antigen status, and stage of human immunodeficiency virus disease. The mean gestational age at delivery and the mean birth weight were similar in the monitored group and the control group. The perinatal transmission rate for the monitored group (29.0%) was not statistically different from that of the control group (25.6%). CONCLUSIONS: If confirmed by larger studies, our findings suggest that the intrapartum use of fetal scalp electrodes or fetal scalp pH sampling does not appear to increase the perinatal transmission of human immunodeficiency virus.

Fetal blood sampling in human immunodeficiency virus--seropositive women before elective midtrimester termination of pregnancy.

OBJECTIVES: To explore the diagnostic potential of fetal blood sampling in the prenatal diagnosis of intrauterine human immunodeficiency virus infection and to investigate the transplacental transfer of human immunodeficiency virus antibody and p24 antigen in the second trimester of pregnancy, we studied serum and amniotic fluid obtained from 13 seropositive women and their fetuses before elective termination of pregnancy. STUDY DESIGN: Enzyme-linked immunosorbent assay, Western blot antibody analyses, and p24 antigen assays were performed on all samples. RESULTS: Human immunodeficiency virus antibody was detected by enzyme-linked immunosorbent assay and Western blot analysis in aliquots of maternal serum, amniotic fluid, and fetal serum from all 13 pregnancies. Each mother-fetus pair had identical antibody banding patterns. In contrast, p24 antigen was found in the maternal serum and amniotic fluid samples from five of 13 women (38%) and in serum from only three of 13 fetuses (23%). CONCLUSIONS: We conclude that fetal blood sampling, if combined with sophisticated serologic analysis, may have the potential to provide the diagnosis of congenital infection with human immunodeficiency virus. The correlation of immunologic, virologic, and molecular biologic methods with subsequent infant outcome and risk of iatrogenic infection of the fetus remains to be determined.

Prevalence and prognostic significance of anticardiolipin antibodies in pregnancies complicated by human immunodeficiency virus-1 infection.

OBJECTIVES: Anticardiolipin antibodies are estimated to occur in 2.2% of all pregnancies and are associated with adverse outcomes including thrombotic events, fetal wastage, intrauterine growth retardation, and preterm delivery. We studied 32 human immunodeficiency virus-seropositive gravidas (1) to determine the prevalence of anticardiolipin antibodies in pregnant women infected with human immunodeficiency virus-1 and (2) to investigate the association between the presence of anticardiolipin antibodies and pregnancy outcome, disease status, and perinatal transmission of human immunodeficiency virus-1. STUDY DESIGN: Serum samples obtained at the first prenatal visit were analyzed for anticardiolipin immunoglobulin M and immunoglobulin G by enzyme-linked immunosorbent assay. Relevant antepartum, intrapartum, and postpartum data, including maternal CD4+ lymphocyte subsets, human immunodeficiency virus p24 antigen determinations, Venereal Disease Research Laboratory test, hematocrit, platelet counts, and placental pathologic tissue of the anticardiolipin antibody-positive and anticardiolipin antibody-negative groups were compared. RESULTS: Test results for 17 (53%) of patients were positive for anticardiolipin antibody: 4 had only immunoglobulin M, 1 had only immunoglobulin G, and the remaining 12 had both antibodies. The patients in the anticardiolipin antibody-positive group were delivered of infants with a mean gestational age of 39 weeks and mean birth weight of 2983 gm. In the anticardiolipin antibody-negative group 15 deliveries had a mean gestational age of 36.3 weeks and a mean birth weight of 2330 gm. CONCLUSIONS: We conclude that there is a high prevalence of anticardiolipin antibodies in patients who have human immunodeficiency virus, which is not associated with adverse maternal or neonatal outcome, maternal human immunodeficiency virus status, or perinatal transmission of human immunodeficiency virus-1.