[The AIDS epidemic and its importance in obstetrics and gynecology]

There is hardly any other disease where differences of opinion are so dramatic as they are in AIDS. Safely established epidemiologic data are interpreted most controversially and heatedly discussed. Gynaecology and obstetrics are no exception; here, too, scientific discussion is marred by emotional overtones. The article attempts to survey update information and to sum up epidemiologic knowledge while trying to strike a balance. Since even the nomenclature is not always clear or uniform, the most important definitions and abbreviations are listed. Special attention is focussed on the problems of the incubation time (3 months to more than 19 years), where in contrast to other diseases it is not the time of manifestation but the final stage of the disease that counts. That an infection may even be transmitted via intact mucosa is a newly established fact. Routes of infection can also be--besides those already known--saliva, gynaecological (vaginal and rectal) specula and possibly a direct iatrogenic infection. At the time of writing (1 January 1989) 82,500 manifest AIDS patients have been recorded in the U.S.A., 46,000 of whom died. There are about 500,000 patients with prestage signs and about 1 to 1.5 million carriers of the virus. Statistics for the Federal Republic of Germany on 31 January 1989 are: 2885 AIDS patients; about 30,000 serum-positive cases; estimated number of virus carriers: ca. 100,000 including about 10,000 women who are capable of bearing children. Switzerland: 702 AIDS patients, about 30,000 virus carriers. Austria: 243 AIDS cases. Figures for other European countries are also stated. The sequence of risk groups is graded. The article also describes the paths of transmittance in their correlation to the individual risk groups. No effective antiviral treatment is at present in sight. Medium-term prognosis for the FRG leads us to expect about 10,000 AIDS cases by the beginning of 1992 (cumulative figure; about half of these patients will have died by that time). The problem of the incidence of mother-to-child transmittance during pregnancy has not yet been clarified. According to latest results the probable quota of infected children is about 40%. Pregnancy care must include the offer of HIV testing; this is in fact mandatory, especially in women with enhanced risk of infection. If the doctor omits this information, he is liable to be sued for damages. Even in late pregnancy stages, testing is still meaningful (vaccination recommendations, newborn and infant care). Special precautionary measures are recommended for parturition. There is as yet no proof of the effectiveness of primary Caesarean section.(ABSTRACT TRUNCATED AT 400 WORDS)