"Vaginal lavage with chlorhexidine during labour to reduce mother to ch" by Gaillard, Philippe, Mwanyumba, Fabian et al.
 

Vaginal lavage with chlorhexidine during labour to reduce mother to child HIV transmission: clinical trial in Mombasa, Kenya.

Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Objectives

To evaluate the effect of vaginal lavage with diluted chlorhexidine on mother-to child transmission of HIV (MTCT) in a breastfeeding population.

Methods

This prospective clinical trial was conducted in a governmental hospital in Mombasa, Kenya. On alternating weeks, women were allocated to non-intervention or to intervention consisting of vaginal lavage with 120 ml 0.2% chlorhexidine, later increased to 0.4%, repeated every 3 h from admission to delivery. Infants were tested for HIV by DNA polymerase chain reaction within 48 h and at 6 and 14 weeks of life.

Results

Enrolment and follow-up data were available for 297 and 309 HIV-positive women, respectively, in the non-lavage and the lavage groups. There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% CI 0.6–1.4) between the groups. Lavage solely before rupture of the membranes tended towards lower MTCT with chlorhexidine 0.2% (OR O.6, 95% CI 0.3–1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% CI 0.0–0.9).

Conclusion

The need remains for interventions reducing MTCT without HIV testing, often unavailable in countries with a high prevalence of HIV. Vaginal lavage with diluted chlorhexidine during delivery did not show a global effect on MTCT in our study. However, the data suggest that lavage before the membranes are ruptured might be associated with a reduction of MTCT, especially with higher concentrations of chlorhexidine.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Aids

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