Complications of cesarean deliveries among HIV-infected women in the United States

Abstract

Objective To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995–1996, 2000–2001, 2005–2006, 2010–2011). Design The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15–49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually. Methods Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined. Results The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010–2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women. Conclusion In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women.

Assessment of mode of delivery and predictors of emergency caesarean section among women living withHIVin a matched‐pair setting with women from the general population in Denmark, 2002−2014

“…In the absence of antiretroviral therapy (ART), caesarean section (CS) has been demonstrated to reduce mother‐to‐child transmission (MTCT) of HIV with 70% compared to vaginal delivery , outweighing the increased morbidity associated with CS . The use of ART in pregnancy and during delivery was found to be effective as a means of preventing MTCT (PMTCT).…”

How to make HIV vertical transmission prevention good value for money in settings with very low HIV prevalence? Using economic evaluation guiding policy in the Philippines

“…Second, the consequences on the women after delivery due to cesarean section was not assessed. These include higher rates of infectious complications and surgical traumas, longer hospital stay and in-hospital deaths [35]. Although it is proven on systematic reviews that cesarean section provides less risk of maternal HIV transmission, the consequences of maternal injuries were not included in the payer's perspective.…”

Delivery After 40 Weeks of Gestation in Pregnant Women With Well-Controlled Human Immunodeficiency Virus

“…Further, in pregnant women with an unfavorable cervix, induction of labor carries an increased risk of prolonged labor, failed induction, and cesarean [3,4]. This is of even greater clinical concern in HIV-1 positive women, given their elevated risk of post-cesarean morbidity and mortality, namely infection, prolonged hospitalization, and ICU admission [5]. Of note, our analysis did not show an increase in cesarean secondary to failed induction, however this may have been skewed by the high proportion of elective cesarean deliveries.…”

“…[1,2] There are no formal guidelines on the timing of delivery for these pregnancies; HIV-1in the absence of a clear standard of care, there is significant variation in clinical practice between institutions and providers, including planned early delivery between 38 and 39 completed weeks, stemming from concern for mother-to-child transmission with advancing gestational age. The risks of induction of labor with an unfavorable cervix include prolonged labor, failed induction and cesarean delivery [3,4]; the risk of serious consequences secondary to these events is heightened for women with HIV-1[5]. Expectant management until late-term is standard of care for uncomplicated HIV-1 negative pregnancies[6,7]; there is no evidence this is contraindicated in pregnancies with well-controlled HIV-1.…”