The incidence of complications after cesarean section in HIV‐infected women with advanced WHO stages of HIV disease

Abstract

Prevalence of HIV infection in Ukraine is 1.6% overall, with antenatal prevalence of 0.52%, the highest in Europe. According to national protocol, cesarean section has been recommended for women with viral load above 50 copies/mL to further prevent vertical transmission of HIV. The aim of our study was to compare the infectious complication rates after cesarean delivery in HIV-infected women with advanced WHO stages of HIV disease who received HAART, and HIV-infected women with I or II WHO stages. Materials and methods: A retrospective analysis was performed on data derived from 150 HIV-infected women with advanced WHO stages of HIV disease (group I) and 150 HIV-infected women with I or II WHO stages (group II), who underwent cesarean delivery. Postoperative infectious morbidity in both groups was analyzed according to whether the cesarean section was an elective or emergent delivery. Descriptive, comparison analyses were performed. Results: There was no significant difference between the both groups in terms of gravidity, parity, number of previous cesarean sections, estimated gestational age at time of delivery. It has been shown that HIV-infected women from the group I have 2 times more factors for the appearance of postpartum infectious complications, such as anemia, the urinary tract infection, sexually transmitted infections. Both groups of women were statistically more likely to experience postpartum endometritis when being delivered by emergent cesarean section than by elective cesarean section (14.6% versus 4.6%, respectively in the group I and 5.3% versus 0.5%, respectively, in the group II), superficial or deep wound breakdown (22.6% versus 4.6%, respectively, in the first group and 5.3% versus 2.6%, respectively, in the second group). Septic pelvic thrombophlebitis was only in 2% of HIV-infected women from the group I. Urinary tract infection had 25% HIV-infected women in the both groups. Overall, the rate of postpartum infectious complications in the first group consist 28%, which was 2 times higher compared the second group. Conclusion: According to our study, there was no significant difference in infectious postoperative morbidity in HIV-infected women who delivered by elective cesarean section in the both groups. But HIV-infected women with advanced WHO stages of HIV disease undergoing emergency cesarean section are at increased risk for post-operative infectious complications

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners

“…Data are limited regarding complications and outcomes of medication abortion in women living with HIV. To date, the largest known study of efficacy and safety of medication abortion in this population was a small case series in Ukraine, which included 68 women living with HIV who were not on ART 65 . In this study, the medication abortion regimen was mifepristone 200 mg orally in the hospital followed by misoprostol 400 mcg sublingually 36 to 48 hours later 66 .…”