Document 0497
 DOCN  M9440497
 TI    Cesarean section to reduce perinatal transmission of human
       immunodeficiency virus. A metaanalysis.
 DT    9404
 AU    Villari P; Spino C; Chalmers TC; Lau J; Sacks HS; Technology Assessment
       Group, Harvard School of Public Health,; Boston, MA 02115.
 SO    Online J Curr Clin Trials. 1993 Jul 8;Doc No 74:[5107 words; 46
       paragraphs]. Unique Identifier : AIDSLINE MED/94138571
 AB    OBJECTIVE: Individual epidemiologic investigations into the association
       between type of delivery and perinatal HIV transmission have been
       suggestive but inconclusive. Metaanalysis was used in an attempt to
       establish if there is, at present, adequate evidence concerning the
       effectiveness of cesarean section in reducing vertical HIV transmission
       rates. METHODS: The MEDLINE data retrieval system and other sources were
       used to identify studies containing data on the relationship between
       type of delivery and vertical HIV transmission. No randomized control
       trials were located. Six cohort studies identified were included in the
       metaanalysis. Crude and, in the only study in which these were
       available, adjusted data were extracted and pooled. RESULTS: The overall
       weighted risk of perinatal HIV infection was 20.2% and 14.0% after
       vaginal and cesarean delivery, respectively. Pooling data of all studies
       showed a statistically significant difference of HIV perinatal
       transmission rates between cesarean and vaginal delivery (odds ratio
       0.65; 95% CI, 0.43 to 0.99; P = 0.044) (Random effects model:
       DerSimonian and Laird method). Approximately 16 (95% CI, 76 to 9)
       HIV-infected women must deliver by cesarean in order to prevent 1 case
       of HIV perinatal infection. CONCLUSIONS: Results of this study show that
       performing elective cesarean section in HIV-infected women is
       potentially an effective procedure. However, the nonexperimental nature
       of the available studies leads us to conclude that randomized control
       trials are indicated before setting specific guidelines for mode of
       delivery in HIV-infected women.
 DE    Bias (Epidemiology)  *Cesarean Section  Delivery  Female  Human  HIV
       Infections/PREVENTION & CONTROL/*TRANSMISSION  Infant, Newborn  Odds
       Ratio  Pregnancy  *Pregnancy Complications, Infectious  Risk Factors
       Support, U.S. Gov't, P.H.S.  JOURNAL ARTICLE  META-ANALYSIS

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).