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PROCAARE: CLINICAL SCIENCE--PERINATAL INFECTION
- From: "Gerard J. Nau (Jerry)" <firstname.lastname@example.org>
- Date: Wed, 19 Jun 1996 09:09:15 -0400 (EDT)
KEYWORDS: TRANSMISSION/ PERINATAL/ MATERNAL/ OBSTETRICS/ RUPTURE OF
MEMBRANES/ CLEANSING/ MALAWI
Reference: Biggar, R.J., Miotti, P.G., Taha, T.E., Mtimavalye, L.,
Broadhead, R., Justesen, A., Yellin, F., Liomba, G., Miley, W., Waters,
D., Chiphangwi, J.D., Goedert, J.J. (1996) Perinatal intervention trial
in Africa: effect of a birth canal cleansing intervention to prevent HIV
transmission. Lancet 347:1647-1650.
This study assessed the impact of a simple intervention on the perinatal
transmission of HIV-1 in Malawi. Nearly 7000 deliveries were included in
the study; 30% of the enrolled women were HIV seropositive and 3637
underwent vaginal cleansing: vaginal cleansing with 0.25% chlorhexidine
gluconate every four hours until delivery as well as washing the infant
after delivery. Women were excluded for complicated deliveres, those who
were in the second stage of labor, or those who could not fully understand.
Importantly, 70% of women presented after they had rupture of membranes
and frequently delivered after only one or two washes.
Subgroup analysis of the results showed that perinatal transmission was
reduced only in those women who had rupture of membranes greater than 4
hours (25.0% in the intervention group versus 39.4% in the control
group). However, there appeared to be no effect on transmission if
cleansing was initiated before or after rupture.
While the authors cautiously point out that multiple subgroup analyses
can sometimes lead to erroneous findings, the results are intriguing
given other findings that show prolonged rupture of membranes to be a
significant risk factor for transmission (see ProCAARE archive.960618).
The authors also mention that the intervention may have a beneficial
effect on Group B streptococcal transmission. A study designed
specifically to compare vaginal cleansing in women with and without
prolonged rupture may demonstrate the benefits of this intervention more