Complications according to mode of delivery among human immunodeficiency virus-infected women with CD4 lymphocyte counts of < or = 500/microL.
OBJECTIVE
We sought to describe rates of and risk factors for complications by delivery mode among human immunodeficiency virus-infected women with CD4 counts of < or = 500/microL.


METHODS
Complication rates were calculated by delivery mode, as follows: planned cesarean delivery performed without labor or rupture of membranes, other cesarean delivery performed after labor or rupture of membranes, or vaginal delivery. Risk factors were evaluated.


RESULTS
Major complications in the planned cesarean delivery (n = 37), other cesarean delivery (n = 95), and vaginal delivery (n = 365) groups were amnionitis or endometritis (16%, 27%, and 7%, respectively), wound infection (5%, 8%, and <1%, respectively), and transfusion (8%, 6%, and 3%, respectively). Any peripartum infection occurred among 16 (18%) of those with a CD4 count of <200/microL and 43 (13%) with a CD4 count of > or =200/microL (P =.17). On multivariate analyses, factors associated with amnionitis-endometritis were cesarean delivery and African American race, and a factor associated with transfusion was third-trimester anemia.


CONCLUSIONS
Endometritis and wound infection occurred more frequently among human immunodeficiency virus-infected women after cesarean than among women undergoing vaginal delivery; however, complication rates overall were within the range reported in human immunodeficiency virus-negative women. Measures to decrease complications in human immunodeficiency virus-infected women, such as greater use of prophylactic antibiotics, should be assessed.
Watts
D H
DH
Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892-7510, USA.
Lambert
J S
JS
Stiehm
E R
ER
Bethel
J
J
Whitehouse
J
J
Fowler
M G
MG
Read
J
J
D000328:Adult; D001803:Blood Transfusion; D016860:CD4 Immunoadhesins; D018791:CD4 Lymphocyte Count; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000150:complications; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D004716:Endometritis / Q000150:complications; D005260:Female; D015483:HIV Antibodies; D015658:HIV Infections / Q000150:complications* / Q000628:therapy; D006679:HIV Seropositivity; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D014946:Wound Infection / Q000150:complications; D015215:Zidovudine / Q000627:therapeutic use
D016860:CD4 Immunoadhesins; D015483:HIV Antibodies; C084715:HIV hyperimmune globulin; D016756:Immunoglobulins, Intravenous; D015215:Zidovudine