Mode of delivery and postpartum morbidity in Latin American and Caribbean countries among women who are infected with human immunodeficiency virus–1: The NICHD International Site Development Initiative (NISDI) Perinatal Study

Duarte, Geraldo; Read, Jennifer S.; Gonin, René; Freimanis, Laura; Ivalo, Silvina; Melo, Victor Hugo; Marcolin, Alessandra Cristina; Mayoral, C.; Ceriotto, Mariana; Souza, Ricardo de; Cardoso, Edmundo; Harris, D.R.

doi:10.1016/j.ajog.2006.01.040

Cited by 21 publications

(19 citation statements)

References 23 publications

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“…4–10, 15–20 The morbidity rate in IMPAACT P1025 population is higher than that reported in a Latin American/Caribbean NICHD International Site Development Initiative (NISDI) cohort of 5% complications overall. 7 The difference cannot be accounted for by viral load suppression variations since IMPAACT P1025 had an 84% rate of viral load ≤400 copies/mL and the NISDI population had a 70% rate. As in the NISDI cohort, IMPAACT P1025 maternal delivery morbidity was more common in women delivering by NECS than by ECS and lowest with vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

“…9 Likewise, data from a Latin American HIV infected pregnant cohort suggested low rates of morbidity. 7 European data also reports conflicting results regarding morbidity. 4, 8, 10 A 2005 Cochrane Meta-analysis of 6 studies suggested a higher rate of postpartum morbidity in HIV infected women but acknowledged the risk was dropping over time.…”

Section: Introductionmentioning

confidence: 99%

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Complications and Route of Delivery in a Large Cohort Study of HIV-1–Infected Women—IMPAACT P1025

Livingston

Huo

Patel

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Investigate complications of cesarean section in a cohort of HIV-infected pregnant women. Methods IMPAACT P1025 is a prospective cohort study of HIV-1-infected women and infants, enrolled 2002 to 2013, at clinical sites in the United States and Puerto Rico. Demographic, medical, and obstetric data were collected and analyzed including cesareans indications. Delivery route was categorized as elective cesarean (ECS, before labor and <5 minutes before membrane rupture), non-elective cesarean (NECS, all other cesareans) or vaginal delivery. Logistic regression models evaluated associations between delivery route and maternal intrapartum/postpartum morbidities. Composite morbidity of vaginal delivery was compared to ECS and NECS. Results This study included 2297 women. 99% used antiretroviral medication and 89% were on a combination antiretroviral therapy regimen. 84% had a HIV-1 viral load ≤400 copies/mL before delivery. 46% (1055) delivered vaginally, 35% (798) by ECS, and 19% (444) by NECS. While interruption of HIV-1 infection was the second most frequent indication for cesarean after repeat cesarean, it decreased as an indication over time. There were no delivery-related maternal mortalities. Overall 19% of women had ≥1 complication(s) - primarily wound complications (14%) or other infections (11%). Vaginal delivery had the lowest complication rate (13%), followed by ECS (23%), and highest NECS (28%) with an overall p<0.001. HIV-1 mother-to-child transmission rates were low and did not differ by delivery mode group. Conclusions HIV interruption as cesarean indicator declined during the study. Morbidity was more common in HIV-infected women delivering by NECS than ECS and lowest with vaginal delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complications and Route of Delivery in a Large Cohort Study of HIV-1–Infected Women—IMPAACT P1025

Livingston

Huo

Patel

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…6,7,14 The risk of complications is highest for emergency cesarean delivery, and intermediate for elective cesarean. 6 In Malawi, cesarean delivery is rare (4.6%) and mostly performed as an emergency without preoperative preparation, 15 so it is not surprising that 91% of cesareans in the BAN Study were emergency procedures and had a higher complication rate than vaginal deliveries.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes among women with HIV infection and their infants in Malawi

Chevalier

King

Ellington

et al. 2017

Intl J Gynecology & Obste

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Objective To describe maternal and neonatal morbidity and mortality among women with HIV infection and their infants. Methods A secondary analysis was undertaken of data obtained in the BAN Study, a trial of postnatal antiretrovirals among pregnant women with HIV infection enrolled in 2004–2010. Mothers and infants had 13 scheduled visits through 48 weeks of follow-up. Serious maternal morbidity and mortality were examined at delivery (n=2791), from delivery to 6 weeks later (n=2369) and from 7 to 48 weeks (n=1980). Neonatal morbidity and mortality were examined (n=2685). Results Of 2791 deliveries, 169 (6.1%) were by cesarean (153 emergency). Compared with women with vaginal delivery, those with cesarean delivery had lower prenatal HIV viral loads (P=0.016) and increased odds of pre-eclampsia/eclampsia (odds ratio [OR] 10.8, 95% CI 4.4–26.8). Women with cesarean delivery also had increased odds of serious infection with 14 days of delivery (OR 3.0, 95% CI 1.3–7.4) and severe anemia (grade 3 or 4) by 6 weeks (OR 6.7, 95% CI 2.3–19.1). Infants born by cesarean had increased odds of a low 5-minute Apgar score (OR 8.1, 95% CI 3.5–18.6) and admission to an intensive care unit (OR 5.4, 95% CI 3.7–7.8). Conclusion Odds of serious maternal and neonatal morbidity were higher after cesarean than vaginal delivery, despite lower maternal viral loads.

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“…One study from Latin America and Caribbean found that postpartum morbidity was approximately 3-fold higher among women having non-scheduled cesarean section (NSCS) than that those with vaginal deliveries (VD). In the same study, morbidity among women with scheduled cesarean section (SCS) was similar to that of vaginal deliveries [7]. The etiology of morbidity following cesarean delivery is multifactorial, and includes severe anemia [3, 8], fever [5, 6, 8], pneumonia [3], UTI [8], and endometritis [5, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

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

Unger

Richardson

Otieno

et al. 2014

BMC Pregnancy Childbirth

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BackgroundThere are limited data on the impact of cesarean section delivery on HIV-1 infected women in Sub-Saharan Africa. The purpose of this study was to assess the effect of mode of delivery on HIV-1 disease progression and postpartum mortality in a Kenyan cohort.MethodsA prospective cohort study was conducted in Nairobi, Kenya from 2000–2005. We determined changes in CD4+ counts, HIV-1 RNA levels and mortality during the first year postpartum between HIV-1 infected women who underwent vaginal delivery (VD), non-scheduled cesarean section (NSCS) and scheduled cesarean section (SCS) and received short-course zidovudine. Loess curves and multivariate linear mixed effects models were used to compare longitudinal changes in maternal HIV-1 RNA and CD4+ counts by mode of delivery. Kaplan Meier curves, the log rank test, and Cox proportional hazards regression were used to assess difference in mortality.ResultsOf 501 women, 405 delivered by VD, 74 delivered by NSCS and 22 by SCS. Baseline characteristics were similar between the VD and NSCS groups. Baseline antenatal CD4+ counts were lowest and HIV-1 RNA levels highest in the NSCS group but HIV-1 RNA levels were similar between groups at delivery. The rate of decline in CD4+ cells and rate of increase in HIV-1 RNA did not differ between groups. After adjusting for confounders, women who underwent NSCS had a 3.39-fold (95% CI 1.11, 10.35, P = 0.03) higher risk of mortality in the first year postpartum compared to women with VD.ConclusionsNon-scheduled cesarean section was an independent risk factor for postpartum mortality in HIV-1 positive Kenyan women. The cause of death was predominantly due to HIV-1 related infections, and not direct maternal deaths, however, this was not mirrored by differential changes in HIV-1 progression markers between the groups.

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Mode of delivery and postpartum morbidity in Latin American and Caribbean countries among women who are infected with human immunodeficiency virus–1: The NICHD International Site Development Initiative (NISDI) Perinatal Study

Cited by 21 publications

References 23 publications

Complications and Route of Delivery in a Large Cohort Study of HIV-1–Infected Women—IMPAACT P1025

Complications and Route of Delivery in a Large Cohort Study of HIV-1–Infected Women—IMPAACT P1025

Maternal and neonatal outcomes among women with HIV infection and their infants in Malawi

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

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