Perioperative morbidity and mortality among human immunodeficiency virus infected women undergoing cesarean delivery.

Abstract

OBJECTIVE:

To determine whether human immunodeficiency virus (HIV)-infected women have a higher rate of postcesarean morbidity and mortality compared with women without HIV infection.

METHODS:

A secondary analysis was performed of women with singleton gestations undergoing cesarean delivery with known HIV status. Data were collected as part of a prospective 4-year (1999-2002) observational study and analyzed using logistic regression. Women were surveyed for a large number of intraoperative complications, common perioperative morbidities, and uncommon maternal complications.

RESULTS:

There were 378 HIV-infected and 54,281 uninfected women who met criteria. Patients infected with HIV were more likely to have postpartum endometritis (11.6% compared with 5.8%, P<.001), require a postpartum blood transfusion (4.0% compared with 2.0%, P=.02), develop maternal sepsis (1.1% compared with 0.2%, P<.001), be treated for pneumonia (1.3% compared with 0.3%, P=.001), and to have a maternal death (0.8% compared with 0.1%, P<.001). After controlling for potential confounders, patients with HIV infection were more likely to have one or more postpartum morbidities (odds ratio 1.6, 95% confidence interval 1.2-2.2).

CONCLUSION:

Women with HIV infection undergoing cesarean delivery are at increased risk for perioperative morbidity and maternal mortality.

LEVEL OF EVIDENCE:

II.

• Authors: Judette Louis, Mark B Landon, Rebecca J Gersnoviez, Kenneth J Leveno, Catherine Y Spong, Dwight J Rouse, Atef H Moawad, Michael W Varner, Steve N Caritis, Margaret Harper, Ronald J Wapner, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer, Maternal-Fetal Medicine Units Network, National Institute of Child Health and Human Development
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 110 Issue 2 Pt 1 Pg. 385-90 (Aug 2007) ISSN: 0029-7844 [Print] United States
• PMID: 17666615 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Cesarean Section (adverse effects, mortality)
• Female
• HIV Infections (complications)
• Humans
• Maternal Mortality
• Morbidity
• Odds Ratio
• Postoperative Complications (mortality)
• Pregnancy
• Pregnancy Complications, Infectious (virology)
• Prospective Studies
• United States (epidemiology)