Postoperative infectious morbidities of cesarean delivery in human immunodeficiency virus-infected women

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.

Postpartum morbidity associated with advanced HIV disease

OBJECTIVE

To investigate the postpartum morbidity and postpartum management of febrile morbidity associated with advanced HIV infection.

METHODS

A case control study of HIV infected women at a tertiary care center during January 2000-June 2005 was performed. Postpartum morbidity was defined as endometritis, blood transfusion, wound complication, readmission, infectious morbidity, or unexpected surgery.

RESULTS

Women in Group 1 had AIDS (N=33), Group 2 were relatively immunocompetent HIV infected women (N=115), and Group 3 were uninfected women (N=152). Group 1 was more likely to have a postpartum morbidity (32.3 versus 19.3 and 13.2%, P=.03) and to have postpartum imaging 18.8 versus 7.9 and 2.6%, P=.002. After controlling for potential confounders, cesarean delivery (OR 6.2, 95% CI 2.1-505.5) but not advanced HIV disease was associated with an increased risk of postpartum morbidity.

CONCLUSION

Cesarean delivery and not advanced HIV disease increases the risk of postpartum morbidity in women with AIDS.