Do caesarean sections reduce the maternal–fetal transmission rate of human papillomavirus infection?

You are the neonatal doctor covering the labour ward. A woman who is 38 weeks pregnant and in early labour reveals a recent history of genital warts. She asks the midwife if this could affect her baby and if it should influence the mode of delivery. The midwife is unsure and so asks you.

Structured clinical question

In a pregnant woman with a history of genital warts [population], does elective caesarean section [intervention] reduce the rate of vertical transmission [outcome]?

Search strategy

Medline via PubMed was the primary source of articles. Search terms were: [genital warts OR papillom* OR HPV OR condylom*] AND [labour OR labor OR delivery OR caesarean]. A second search using [papillom*] AND [vertical] was also performed.

Limits were: humans and English language. Dates included 1966 to October 2008.

Secondary searches on the Cochrane database, Clinical Evidence and SUMsearch were performed using the same search terms.

Search outcome

A total of 295 papers were found via PubMed, eight of which were relevant. The references of the above papers were scanned, along with the linked articles, but no further articles were found.

A review,1 which partly looked at this question, had been carried out in 2005, but due to only partial analysis of data, the original articles were reviewed instead. See table 2.

No additional articles were found via secondary sources or by using the second search terms.

Comments

There are more than 100 genotypes of human papillomavirus, of which at least 40 are known to infect the genital area. Although seropositivity is documented to be highest in the second decade of life,10 most studies investigating the age-specific …