Mode of delivery and postpartum HIV-1 disease progression and mortality in a Kenyan cohort

“…One observational study in Kenya examined maternal mortality [ 48 ]. Eight deaths were reported of the 405 women delivering vaginally, five of the 74 given non-ECS, and none of the 22 given ECS [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

Elective cesarean section for women living with HIV

Kennedy

Yeh

Pandey

et al. 2017

Aids

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“…Unintended pregnancies for all women can have negative health, economic and social consequences for the woman and child, including increased maternal morbidity and mortality, poor breastfeeding and nutritional status and infant mortality [ 3 ]. For HIV-positive women, the likelihood of adverse health outcomes associated with pregnancy are elevated due to a number of factors including faster decline in CD4 count after pregnancy, HIV-related infections and co-morbid conditions (for example, diabetes) [ 4 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Family planning use and fertility desires among women living with HIV in Kenya

et al. 2015

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BackgroundEnabling women living with HIV to effectively plan whether and when to become pregnant is an essential right; effective prevention of unintended pregnancies is also critical to reduce maternal morbidity and mortality as well as vertical transmission of HIV. The objective of this study is to examine the use of family planning (FP) services by HIV-positive and HIV-negative women in Kenya and their ability to achieve their fertility desires.MethodsData are derived from a random sample of women seeking family planning services in public health facilities in Kenya who had declared their HIV status (1887 at baseline and 1224 at endline) and who participated in a longitudinal study (the INTEGRA Initiative) that measured the benefits/costs of integrating HIV and sexual/reproductive health services in public health facilities. The dependent variables were FP use in the last 12 months and fertility desires (whether a woman wants more children or not). The key independent variable was HIV status (positive and negative). Descriptive statistics and multivariate logistic regression analysis were used to describe the women’s characteristics and to examine the relationship between FP use, fertility desires and HIV status.ResultsAt baseline, 13 % of the women sampled were HIV-positive. A slightly higher proportion of HIV-positive women were significantly associated with the use of FP in the last 12 months and dual use of FP compared to HIV-negative women. Regardless of HIV status, short-acting contraceptives were the most commonly used FP methods. A higher proportion of HIV-positive women were more likely to be associated with unintended (both mistimed and unwanted) pregnancies and a desire not to have more children. After adjusting for confounding factors, the multivariate results showed that HIV-positive women were significantly more likely to be associated with dual use of FP (OR = 3.2; p < 0.05). Type of health facility, marital status and household wealth status were factors associated with FP use. Factors associated with fertility desires were age, education level and household wealth status.ConclusionsThe findings highlight important gaps related to utilization of FP among WLHIV. Despite having a greater likelihood of reported use of FP, HIV-positive women were more likely to have had an unintended pregnancy compared to HIV-negative women. This calls for need to strengthen family planning services for WLHIV to ensure they have better access to a wide range of FP methods. There is need to encourage the use of long-acting reversible contraceptive (LARC) to reduce the risk of unintended pregnancy and prevention of vertical transmission of HIV. However, such policies should be based on respect for women’s right to informed reproductive choice in the context of HIV/AIDS.Trial registrationNCT01694862

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“…Two of these studies described risk factors for MTCT [ 36 , 37 ]. Unger et al analyzed the use of CS over time, and assessed postpartum morbidity and mortality; but they did not discuss why the use of CS increased over time [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT?

Tenthani

Oosterhout

Haas

et al. 2018

BMC Pregnancy Childbirth

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BackgroundCaesarean section (CS) is not recommended for PMTCT in Malawi HIV Guidelines, contrary to most high-income countries where CS is indicated if viral suppression is sub-optimal pre-delivery. We describe patterns of CS in HIV-infected and uninfected women in Malawi and explored if insight into the use of Elective CS (ECS) for PMTCT could be obtained.MethodsWe used routinely collected data from individual medical records from 17 large health facilities in the central and southern regions of Malawi, from January 2010 to December 2013. We included data from maternity registers from all HIV-positive women, and randomly selected around every fourth woman with negative or unknown HIV status. We used multivariable logistic regressions and cluster-based robust standard errors to examine independent associations of patient- and facility characteristics with CS and ECS.ResultsWe included 62,033 women in the analysis. The weighted percentage of women who had a spontaneous vaginal delivery was 80.0% (CI 95% 79.5–80.4%); 2.4% (95% CI 2.3–2.6%) had a vacuum extraction; 2.3% (95% CI 2.2–2.5%) had a vaginal breech delivery; 14.0% (95% CI 13.6–14.4%) had a CS while for 1.3% (95% CI 1.2–1.4%) the mode of delivery was not recorded. Prevalence of CS without recorded medical or obstetric indication (ECS) was 5.1%, (n = 3152). Presence of maternal and infant complications and older age were independently associated with CS delivery. HIV-positive women were less likely to have ECS than HIV negative women (aOR 0.65; 95%-CI 0.57–0.74). Among HIV-positive women, those on antiretrovirals (ARV’s) for ≥4 weeks prior to delivery were less likely to have ECS than HIV-positive women who had not received ARVs during pregnancy (aOR 0.81; 95% CI 0.68–0.96).ConclusionsThe pattern of CS’s in Malawi is largely determined by maternal and infant complications. Positive HIV status was negatively associated with CS delivery, possibly because health care workers were concerned about the risk of occupational HIV transmission and the known increased risk of post-operative complications. Our results leave open the possibility that CS is practiced to prevent MTCT given that ECS was more common among women at high risk of MTCT due to no or short exposure to ARV’s.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1722-4) contains supplementary material, which is available to authorized users.

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Mode of delivery and postpartum HIV-1 disease progression and mortality in a Kenyan cohort

Cited by 6 publications

References 17 publications

Elective cesarean section for women living with HIV

Elective cesarean section for women living with HIV

Family planning use and fertility desires among women living with HIV in Kenya

Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT?

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