title: Maternal and fetal outcomes of HIV-infected and non-infected pregnant women admitted to two intensive care units in Pietermaritzburg, South Africa.
abstract: BACKGROUND
  Outcomes of HIV-positive pregnant patients admitted to intensive care units (ICUs) are controversial.
  
  
  OBJECTIVE
  To determine maternal and fetal outcomes of HIV-positive patients admitted to ICUs.
  
  
  METHODS
  Pregnant patients admitted to ICUs were enrolled in the study. On admission, they were classified as having low (<50%) or high (≥50%) risk of death by GRAMPT stratification score. The primary maternal outcome was death or hypoxic-ischaemic brain injury (HIBI), while fetal outcomes recorded were Apgar score, birth weight, and delivery of the fetus to facilitate maternal care.
  
  
  RESULTS
  There were 84 admissions to the ICUs: 66 (78.6%) were post-partum and 18 (21.4%) antepartum. The HIV sero-status was as follows: 11 (13.1%) HIV status unknown; 42 (50%) HIV-negative and 31 (36.9%) HIV-positive. The most common pre-ICU admission diagnoses were pneumonia (19.4%) in HIV-positive patients and eclampsia (31%) in HIV-negative patients. Maternal outcomes showed a worsening trend among the HIV-positive women when compared with those who were HIV-negative (high GRAMPT, 1.91 relative risk of death/HIBI in HIV-positive; 95% CI 0.57 - 6.44). Forty-two patients gave birth within 24 hours prior to ICU admission; 3 gave birth while in ICU and none gave birth within 24 hours following ICU discharge. Outcomes of the 45 infants born to HIV-positive women were worse than for those born to HIV-negative patients (except for Apgar scores 1 - 6). Performance of the GRAMPT model for prediction of maternal mortality/HIBI was best in hypertensive patients (ROC: AUC 0.72; 95% CI 0.48 - 0.96).
  
  
  CONCLUSIONS
  With the exception of Apgar scores 1 - 6, all outcomes showed worsening trends among infants born to HIV-positive mothers. Large multicentre studies are needed to confirm our findings.
authors.affiliation: Department of Obstetrics and Gynaecology, Grey's Hospital, Pietermaritzburg, South Africa. ngenenc@gmail.com
authors.forename: N C
authors.initials: NC
authors.lastname: Ngene
authors.forename: J
authors.initials: J
authors.lastname: Moodley
authors.forename: P
authors.initials: P
authors.lastname: Songca
authors.forename: R
authors.initials: R
authors.lastname: von Rahden
authors.forename: F
authors.initials: F
authors.lastname: Paruk
authors.forename: C O
authors.initials: CO
authors.lastname: Onyia
authors.forename: S
authors.initials: S
authors.lastname: van der Linde
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology; D007231:Infant, Newborn; D007362:Intensive Care Units; D063130:Maternal Death; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D013019:South Africa