Postoperative Infectious Morbidities of Cesarean Delivery in Human Immunodeficiency Virus-Infected Women

Abstract

Objective. To compare the infectious complication rates from cesarean delivery of human immunodeficiency virus (HIV)-infected women and HIV-negative women. Materials and Methods. A retrospective analysis was performed on data derived from HIV-infected women and HIV-negative women, who underwent cesarean delivery at two teaching hospitals. Main outcome measures were infectious postoperative morbidity. Descriptive, comparison analysis, and multiple logistic regression analysis were performed. Results. One hundred and nineteen HIV-infected women and 264 HIV-negative women delivered by cesarean section and were compared. The HIV-negative women were more likely than the HIV-infected women to deliver by emergent cesarean section (78.0% versus 51.3%, resp., P < .05), to labor prior to delivery (69.4% versus 48.3%, resp., P < .01), and to have ruptured membranes prior to delivery (63.5% versus 34.8%, resp., P < .05). In bivariate analysis, HIV-infected and HIV-negative women had similar rates of post-operative infectious complications (16.8% versus 19.7%, resp., P > .05). In a multivariate stepwise logistic analysis, emergent cesarean delivery and chorioamnionitis but not HIV infection were associated with increased rate of post-operative endometritis (odds ratio (OR) 4.10, 95% confidence interval (95% CI) 1.41–11.91, P < .01, and OR 3.02, 95% CI 1.13–8.03, P < .05, resp.). Conclusion. In our facilities, emergent cesarean delivery and chorioamnionitis but not HIV infection were identified as risk factors for post-operative endometritis.

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

“…Based on previous studies of mode of delivery and maternal morbidity, maternal disease severity measures including last CD4 count, viral load, CDC classification during pregnancy, and clinical diagnoses during pregnancy were forced in all final multiple regression models to adjust for potential confounding by indication. 4–6, 9, 10 Odds ratios and 95% confidence intervals were obtained from the final regression models as estimates of the adjusted association between mode of delivery and each maternal morbidity outcome. Statistical significance was defined as two-sided p-value < 0.05.…”

“…5 A later study from New Orleans suggested morbidity in HIV infected women undergoing cesarean was due to other co-morbidities aside from HIV. 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.…”

Clinical and epidemiological profile and reproductive outcome in hiv-infected pregnant women assisted at a university hospital maternity in vitória, brazil

“…In previous studies, it was not found higher frequency of puerperal infection in pregnant women infected with HIV (23,24) . Few studies report higher incidence of birth of female fetuses (25,26) , which constitutes a peculiar finding of the present study, maybe relevant because there are more reports of TV for female fetuses (27) .…”

BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

“…More recent cohort data from Europe and from case controlled studies in the USA and the UK involving women on cART with undetectable viral loads have demonstrated very low rates of maternal morbidity, irrespective of mode of delivery.…”