A 27-year-old HIV-positive woman at 37 weeks of gestation has been non-adherent to antiretroviral therapy. Her plasma HIV RNA is 1,800 copies/mL. She is in early labour with intact membranes. What is the recommended mode of delivery to reduce vertical transmission?
- A Spontaneous vaginal delivery with intrapartum zidovudine
- B Scheduled caesarean delivery before onset of labour ✓
- C Assisted vaginal delivery with forceps
- D Vaginal delivery with postnatal infant monotherapy
Correct answer: B. Scheduled caesarean delivery before onset of labour
Explanation
When maternal viral load exceeds 1,000 copies/mL near delivery, scheduled caesarean section performed before labour and before rupture of membranes significantly lowers vertical transmission risk, alongside intravenous zidovudine and neonatal post-exposure prophylaxis. With sustained viral suppression below 50 copies/mL, vaginal delivery is safe, but detectable viraemia at term changes the recommendation. Forceps do not reduce transmission and may increase fetal exposure to blood.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.