702   Increasing Trends in Cesarean Sections in HIV- Infected Mothers of Infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort.

K. Dominguez¹, M. Lindegren¹, M. Fowler¹, V. Peters², I. Ortiz², T. Frederick², T. Rakusan², H. Hsu², S. Melville², P. D'Almada¹, and the PSD Consortium².
¹CDC, Atlanta, GA and²PSD Project, United States.

Background:In 1998, findings from a clinical trial and a meta-analysis demonstrated that cesarean section (c/s) was associated with a 50% reduction in the risk of perinatal HIV transmission (PHT). In 7/99, the American College of Obstetrics and Gynecology published guidelines for the offering of scheduled c/s at 38 weeks gestation to HIV+ women.

Methods:PSD is a longitudinal medical record review of HIV-exposed infants in 6 areas in the U.S. Trends and factors associated with c/s were examined in PSD between 1/1/94 and 7/1/00 and compared to pediatric HIV/ AIDS surveillance data.

Results:of the 7,169 deliveries, 1,754 (25%) were c/s, 4,736 (66%) were vaginal and 679 (9%) were unknown. The proportion of deliveries by c/s (% c/s) increased from 19% in 1994 to 44% in 2000, with the largest increase during 1999. Surveillance data showed similar trends. The % c/s varied by site, although all increased over time. On univariate analysis, c/s was associated with having prenatal care (PNC) (P<0.001), knowing maternal HIV infection status prior to delivery (P<0.001), having maternal HIV symptoms at time of birth (P<0.001) and having private insurance (P<0.001). Maternal race/ethnicity and injecting drug use were not associated with c/s.

Conclusions:From 1997 through 2000, the % c/s for HIV+ women doubled. Increasing the rates of PNC and voluntary prenatal HIV counseling and testing will allow offering of elective c/s and antiretrovirals to HIV+ pregnant women to further maximally reduce the risk of PHT in the U.S.