Differences in postpartum morbidity in women who are infected with the human immunodeficiency virus after elective cesarean delivery, emergency cesarean delivery, or vaginal delivery.
OBJECTIVE
The aim of this study was to assess the impact of elective cesarean delivery on postpartum morbidity in women who are infected with the human immunodeficiency virus (HIV).


METHODS
We performed a retrospective study of 401 women who were infected with HIV who were delivered in a single reference center from 1989 through 1999. Women who had cesarean deliveries (n = 201), of which 109 were elective and 92 were emergency, were compared with a group of women who were delivered vaginally (n = 200), composed of the women who were infected with HIV preceding each cesarean delivery.


RESULTS
One or more serious complications occurred after 12% of emergency cesarean deliveries, after 6.4% of elective cesarean deliveries, and after 4% of vaginal deliveries (P =.04). In a multivariate analysis, which was adjusted for maternal CD4 lymphocyte count and antepartum hemorrhage, the relative risk of any postpartum complication (serious or minor) was increased by 1.85 (range, 1.00-3.39) after elective cesarean delivery and 4.17 (range, 2.32-7.49) after emergency cesarean delivery, compared with vaginal deliveries (P =.0001).


CONCLUSIONS
Postpartum morbidity in women who are infected with HIV was highest after emergency, rather than elective, cesarean deliveries.
Marcollet
Anne
A
Department of Obstetrics and Gynecology, Hôpital Cochin, Paris, France.
Goffinet
François
F
Firtion
Ghislaine
G
Pannier
Emmanuelle
E
Le Bret
Thiphaine
T
Brival
Marie-Laure
ML
Mandelbrot
Laurent
L
D000328:Adult; D000740:Anemia / Q000453:epidemiology; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004638:Emergency Treatment; D005260:Female; D005334:Fever / Q000453:epidemiology; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000150:complications* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D009017:Morbidity; D011183:Postoperative Complications; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011644:Puerperal Disorders / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies
D000998:Antiviral Agents; D012367:RNA, Viral