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Obstetrics & Gynecology 2007;110:385-390
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Perioperative Morbidity and Mortality Among Human Immunodeficiency Virus–Infected Women Undergoing Cesarean Delivery

Judette Louis, MD, MPH1, Mark B. Landon, MD2, Rebecca J. Gersnoviez, MS3, Kenneth J. Leveno, MD4, Catherine Y. Spong, MD5, Dwight J. Rouse, MD, MSPH6, Atef H. Moawad, MD7, Michael W. Varner, MD8, Steve N. Caritis, MD9, Margaret Harper, MD10, Ronald J. Wapner, MD11, Menachem Miodovnik, MD12,13, Marshall Carpenter, MD14, Alan M. Peaceman, MD15, Mary J. O'Sullivan, MD16, Baha M. Sibai, MD17, Oded Langer, MD18, John M. Thorp, MD19, Susan M. Ramin, MD20, Brian M. Mercer, MD21 for the National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network*

From 1Wayne State University, Detroit, Michigan; 2Ohio State University, Columbus, Ohio; 3The George Washington University Biostatistics Center, Washington, DC; 4University of Texas Southwestern Medical Center, Dallas, Texas; 5National Institute of Child Health and Human Development, Bethesda, Maryland; 6University of Alabama at Birmingham, Birmingham, Alabama; 7University of Chicago, Chicago, Illinois; 8University of Utah, Salt Lake City, Utah; 9University of Pittsburgh, Pittsburgh, Pennsylvania; 10Wake Forest University, Winston-Salem, North Carolina; 11Thomas Jefferson University, Philadelphia, Pennsylvania; 12University of Cincinnati, Cincinnati, Ohio; 13Columbia University, New York, New York; 14Brown University, Providence, Rhode Island; 15Northwestern University, Chicago, Illinois; 16University of Miami, Miami, Florida; 17University of Tennessee, Memphis, Tennessee; 18University of Texas at San Antonio, San Antonio, Texas; 19University of North Carolina, Chapel Hill, North Carolina; 20University of Texas at Houston, Houston, Texas; 21Case Western Reserve University, Cleveland, Ohio.

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






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