title: Complications of cesarean deliveries among HIV-infected women in the United States.
abstract: OBJECTIVE
  To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995-1996, 2000-2001, 2005-2006, 2010-2011).
  
  
  METHODS
  The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15-49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually.
  
  
  METHODS
  Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined.
  
  
  RESULTS
  The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010-2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women.
  
  
  CONCLUSIONS
  In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women.
authors.affiliation: Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Sascha
authors.initials: S
authors.lastname: Ellington
authors.forename: Karen
authors.initials: K
authors.lastname: Pazol
authors.forename: Lisa
authors.initials: L
authors.lastname: Flowers
authors.forename: Lisa
authors.initials: L
authors.lastname: Haddad
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections; D006470:Hemorrhage / Q000453:epidemiology; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D013530:Surgical Wound Infection / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology; D055815:Young Adult