European journal of obstetrics, gynecology, and reproductive biology · 1998
Pregnancy outcome in women with beta-thalassemia major and HIV infection.
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Kumar R M, Khuranna A
Аннотация
OBJECTIVES: To conduct a study of maternal and foetal outcome in pregnant transfusion-dependent beta-thalassemia major (beta-TM) women with HIV-1 disease.
STUDY DESIGN: The course and outcome of pregnancy was studied prospectively in 123 women with transfusion-dependent beta-thalassemia major, of which 81 were HIV-1 positive, at Sanjay Gandhi hospital Manipur, India, from January 1990 to January 1997. The clinical and immunological status of the seropositive women was compared with matched seronegative thalassemic control groups.
RESULTS: Over a period of 7 years, 123 women with beta-TM conceived. One hundred and eleven (90%) conceptions were spontaneous including the 81 HIV-1 positive women and 12 (10%) conceptions occurred after induction of ovulation. Among these 81 patients the following stages of HIV-1 infection were represented: 39 C2 stage (AIDS indicator conditions); 42 A2 stage (asymptomatic) (CDC 1993). Of these 39 women, 12/39 (31%) underwent medical termination of pregnancy (MTP) by 8 weeks gestation and five (13%) died undelivered by 32 weeks gestation due to fulminating pneumocystis carinii pneumonia. There were 80/123 (65%) singleton vaginal deliveries of which 22/80 (28%) were preterm and 58 (71%) term. All 22 preterm births occurred in mothers with aids indicator conditions, were vaginal deliveries, and they had positive viral cultures for HIV-1 within one week of birth. Ten of these neonates died by 8 weeks of AIDS and the remaining 12 died of AIDS indicator disease by 15 months of age. At term a significant 25% (31/123) of women delivered by elective caesarean section due to cephalopelvic disproportion. Except for those inflicted with AIDS, the remaining women remained well throughout pregnancy.
CONCLUSION: Successful outcome of pregnancies does occur in women with beta-TM and also in those with asymptomatic HIV disease. Associated AIDS indicator conditions cause appreciable perinatal and maternal morbidity and mortality.
STUDY DESIGN: The course and outcome of pregnancy was studied prospectively in 123 women with transfusion-dependent beta-thalassemia major, of which 81 were HIV-1 positive, at Sanjay Gandhi hospital Manipur, India, from January 1990 to January 1997. The clinical and immunological status of the seropositive women was compared with matched seronegative thalassemic control groups.
RESULTS: Over a period of 7 years, 123 women with beta-TM conceived. One hundred and eleven (90%) conceptions were spontaneous including the 81 HIV-1 positive women and 12 (10%) conceptions occurred after induction of ovulation. Among these 81 patients the following stages of HIV-1 infection were represented: 39 C2 stage (AIDS indicator conditions); 42 A2 stage (asymptomatic) (CDC 1993). Of these 39 women, 12/39 (31%) underwent medical termination of pregnancy (MTP) by 8 weeks gestation and five (13%) died undelivered by 32 weeks gestation due to fulminating pneumocystis carinii pneumonia. There were 80/123 (65%) singleton vaginal deliveries of which 22/80 (28%) were preterm and 58 (71%) term. All 22 preterm births occurred in mothers with aids indicator conditions, were vaginal deliveries, and they had positive viral cultures for HIV-1 within one week of birth. Ten of these neonates died by 8 weeks of AIDS and the remaining 12 died of AIDS indicator disease by 15 months of age. At term a significant 25% (31/123) of women delivered by elective caesarean section due to cephalopelvic disproportion. Except for those inflicted with AIDS, the remaining women remained well throughout pregnancy.
CONCLUSION: Successful outcome of pregnancies does occur in women with beta-TM and also in those with asymptomatic HIV disease. Associated AIDS indicator conditions cause appreciable perinatal and maternal morbidity and mortality.