The relationship of the duration of ruptured membranes to vertical transmission of human immunodeficiency virus.

OBJECTIVE: Intrapartum events may play a role in determining the likelihood of vertical transmission of human immunodeficiency virus-1. Timing and duration of rupture of membranes have been shown to modify transmission risk of other organisms but have not been examined for human immunodeficiency virus. This study was undertaken to assess the relationship between duration of rupture of membranes, maternal immune status, and transmission of human immunodeficiency virus. METHODS: The Mothers' and Infants' Cohort Study enrolled 207 human immunodeficiency virus-positive women and their infants at five study sites in Brooklyn and the Bronx, New York between January 1986 and January 1991. One hundred twenty-seven woman-infant sets for whom antepartum CD4+ levels were available, the infant's human immunodeficiency virus infection outcome was known, and the duration of ruptured membranes could be determined were included in this analysis. RESULTS: Thirty of the 127 evaluable infants (24%) were infected. Women with low CD4+ levels (< 20%) were significantly more likely to transmit the virus if rupture of membranes was > or = 4 hours (relative risk 4.53, 95% confidence interval 1.14 to 1.81, p = 0.02). The same association was not observed among women with higher CD4+ levels (relative risk 1.11, 95% confidence interval 0.52 to 2.69, p = 0.69). No association with the duration of labor or mode of delivery was seen. CONCLUSIONS: In this urban North American cohort women with low CD4+ levels were significantly more likely to transmit human immunodeficiency virus to their offspring if the duration of rupture of membranes was > or = 4 hours.

Cocaine using during pregnancy and low birth weight: the impact of prenatal care and drug treatment.

Cocaine use in pregnancy has been associated with low birth weight. Large population-based studies suggest that 5 to 7% of pregnant women have used cocaine, with much higher rates in low income inner-city women. Among 140 births at our institution of cocaine-using women, we found a lower rate of low birth weight in those who received prenatal care compared with those without prenatal care: 33 of 96 (34.3%) versus 23 of 44 (52.3%), P < .05. A review of the literature shows that comprehensive care, which includes both prenatal care and drug treatment, seems to be associated with better birth weight outcomes, particularly in women who stop their use in the first trimester. Prenatal care alone, however, is also associated with improved outcomes even if not specialized or linked to drug treatment.

Human immunodeficiency virus disease in pregnancy.

Since the early 1990s, the number of women diagnosed with the human immunodeficiency virus (HIV) has exploded. Heterosexual women have become one of the fastest-growing populations of newly diagnosed cases. However, the full impact of HIV infection and acquired immunodeficiency syndrome (AIDS) on women's health and the optimal management of symptomatic and asymptomatic cases have yet to be delineated. The urgency to establish effective management protocols is underscored by the fact that AIDS has recently become the leading cause of death for minority women in many urban areas. The administration of antepartum and intrapartum zidovudine (azidothymidine, AZT) has advanced efforts to minimize perinatal transmission and produced promising results. However, important issues pertaining to prevention of HIV infection in women, mandatory testing of women of reproductive age, and the management of HIV-positive women during the interconceptional period remain controversial. Addressing HIV throughout the continuum of reproductive health is a major priority and a concern of all health care providers. Women's health care must assume the lead in counseling all women about their risk of HIV, ensuring that HIV-positive women make informed decisions about their reproductive health and that HIV-negative women modify high-risk behavior to avoid becoming infected. Since obstetricians and gynecologists, nurse practitioners, and midwives are often the first care providers whom at-risk and HIV-infected women contact, they must be able to identify, assess, and optimally manage these patients. This article reviews the epidemiology, virology, pathology, preconceptional counseling/testing, and management of women with HIV infection in pregnancy, thereby providing the practitioner with information and tools to enhance women's health.

Decreased maternal-fetal attachment in methadone-maintained pregnant women: a preliminary study.

Maternal-fetal attachment represents the mother's affiliation and interaction with her unborn fetus. It develops during pregnancy and may be critical to successful mother-infant adaptation. The purpose of this study was to investigate maternal-fetal attachment in methadone-maintained pregnant women. We studied a cross-sectional sample of women (n = 67), 15 to 35 years of age, with uncomplicated, singleton pregnancies, at 28 to 37 weeks of gestation. The study population comprised two groups: group 1 consisted of 17 women enrolled in a substance abuse program who were using methadone, 40 to 80 mg a day, for a period of more than 3 months; group 2 included 50 women with no history of substance abuse. The Cranley 24-item scale was used as a measure of maternal-fetal attachment. Methadone-maintained pregnant women had diminished maternal-fetal attachment scores compared with controls (P < .05). This may be attributed to methadone use or to behavior characteristics of women with substance abuse. In either case, decreased maternal-fetal attachment may conceivably reduce women's compliance with prenatal health care, interfere with maternal adjustment during pregnancy, and/or have negative long-term effects on mother-child attachment.

A rapid test for the detection of human immunodeficiency virus antibodies in cord blood.

A commercially available rapid test (HIVCHEK) was compared with an enzyme-linked immunosorbent assay (ELISA) for identifying human immunodeficiency virus type 1 in the serum of newborn infants. Of 1309 cord blood samples tested, the HIVCHEK test detected all the true-positive samples detected by ELISA. Of the 35 samples with positive ELISA results, six had negative results on Western blot; only 1 of the 30 samples with positive HIVCHEK results had negative results on Western blot. Thus the HIVCHEK test can be used to facilitate the rapid identification of HIV-1 in the serum of newborn infants.

Heart rate patterns and fetal sepsis.

Fetal heart rate patterns from 15 cases of in utero bacterial fetal sepsis were reviewed. All patterns contained some abnormality, the most common being persistent tachycardia. Ninety-three percent of fetuses had periodic decelerations, which were either late or variable in nature. Neither maternal fever nor fetal tachycardia was invariably present during fetal infection. Although fetal sepsis was associated frequently with fetal heart rate pattern aberrations, no specific pattern was identified that was consistently or uniquely related to infection.