The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for AZT administration to the seroconverted pregnant women for reduction of perinatal transmission. 4. There should be available the appropriate back up services for seropositive pregnant women such as: (i) C--Choice. Having been appropriately counselled the pregnant women should be able to terminate or continue with the pregnancy. (ii) H--High-risk pregnancy concept. The pregnant women should be treated as high-risk cases. Throughout their pregnancy and delivery only experienced personnel should manage them. (iii) I--Integrated services. From our experience it would be reasonable to integrate the care of seropositive pregnant women with any other high-risk cases. Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.
PIP: During January 1991-December 1993 at Ramathibodi Hospital in Bangkok, Thailand, 91 of 24,856 (0.36%) pregnant women screened at their first prenatal visit for HIV tested positive for HIV antibodies. All were asymptomatic. AZT (Azidothymidine) was not administered. 8% of the HIV-seropositive women later admitted that they already knew their HIV status before coming for prenatal care from blood tests at other institutions. Eight women who tested HIV seronegative at the first screening tested HIV seropositive during the second routine screening at 28-32 weeks gestation, for a seroconversion rate of 0.03/100 seronegative tests at first screening. Researchers compared the 91 pregnant women testing HIV seropositive at the first screening with 182 HIV-seronegative pregnant women. After pretest counseling (a video presentation and information on voluntary testing), 100% of all pregnant women agreed to undergo HIV testing. The HIV seroprevalence rate increased from 0.13% to 0.47% during the study period. The leading risk factor for HIV infection was multiple sex partners (26.4% vs. 8.8%; p 0.05). The partners of 12% of the HIV-seropositive pregnant women tested HIV seronegative, resulting in considerable anxiety and difficulty in counseling the couples. After post-test counseling, 85.7% of the original 91 women opted for induced abortion. 13 of the original women and all of the seroconverted cases continued the pregnancy. The pregnant women who seroconverted made up 38% of the deliveries. The perinatal transmission rate was 19%. Infants born to the 8 mothers who seroconverted were more likely to test HIV positive than those born to mothers who tested positive at the first screening (37.5% vs. 7.7%; p 0.05). AZT administration to these women would have likely reduced the perinatal transmission rate. An infection led to the death of 1 infant in the seroconverted group at 5 months. Pregnancy outcomes did not differ between the HIV-seropositive group and the HIV-seronegative group.