Preventing perinatal transmission. (Hepatitis, HIV, Group B Strep).

PALM BEACH, FLA. -- Strict adherence to the latest protocols can shrink the danger of perinatal transmission of maternal hepatitis, HIM and group B Streptococcus, experts said at the annual meeting of District V of the American College of Obstetricians and Gynecologists.

Criteria for when to test, whether to treat, and which drugs to use keep evolving, said Dr. Patrick Duff of the University of Florida, Gainesville.

Recommendations for cesarean delivery are also in flux, said Dr. Stanley Gall of the University of Louisville (Ky).

Guidelines for prevention of HIV transmission have undergone change. "We now know that the optimal treatment for adults, including pregnant women, is a three-drug combination"--combavir (AZT plus 3TC) and nelfinavir (Viracept), Dr. Duff said.

Lab studies should be done at regular intervals, including CD4 count, viral load, and STD screens. Immunocompromised patients should receive a TB screen and undergo cytomegalovirus and toxoplasmosis serology dose to the time of delivery.

"But I do not think every HIV-positive patient should have a cesarean section," he said. A woman on combination therapy without a detectable viral load can be delivered vaginally for example, but a scalp pH and the use of instruments are contraindicated. C-section can reduce the rate of transmission by about 50% for patients on monotherapy or not on antiviral therapy at all.

Offer a cesarean delivery to a patient who's receiving combination therapy but still has a detectable viral load, Dr. Duff recommended. "But if a woman scheduled for C-section presented in labor with ruptured membranes, I would do a vaginal delivery and administer intrapartum medication," he said.