Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010

Briand, Nelly; Jasseron, Carine; Sibiude, Jeanne; Azria, Élie; Pollet, Justine; Hammou, Yamina; Warszawski, Josiane; Mandelbrot, Laurent

doi:10.1016/j.ajog.2013.06.021

Cited by 68 publications

(49 citation statements)

References 44 publications

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“…Given that major complications are rare, these smaller studies were insufficiently powered to evaluate the comparative frequencies for the more severe outcomes. In a third population-based recent study of HIV-infected women in France, complication rates were lower following vaginal, compared with cesarean delivery; complications were mainly infections or hemorrhage [38]. Whereas the unadjusted rate of hemorrhage was higher among HIV-infected women in this study, when adjusting for sociodemographic factors and underlying morbidity the risk became lower, compared with HIV-uninfected women.…”

Section: Discussionmentioning

confidence: 51%

Complications of cesarean deliveries among HIV-infected women in the United States

Kourtis

Ellington

Pazol

et al. 2014

Aids

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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). Design 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 51%

Complications of cesarean deliveries among HIV-infected women in the United States

Kourtis

Ellington

Pazol

et al. 2014

Aids

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“…In Australia, universal screening for syphilis is recommended in pregnancy, with a treponemal-specific serological assay performed at the first antenatal visit, and repeat screening in high-risk populations should be considered at 28 weeks 10,11 . Modalities available for diagnosing congenital syphilis in Australia include both treponemalspecific and non-treponemal specific serology, nucleic acid detection, direct fluorescent antibody testing, and histochemical staining (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Under the Microscope Historically, elective Caesarean section was recommended as an intervention to reduce perinatal transmission, although the data to support this were primarily before the advent of combination therapy with more recent analyses suggesting the risk of perinatal HIV transmission is comparable in women with an undetectable viral load 10,11 . Today, vaginal birth is the recommended mode of delivery in women with an undetectable viral load (defined as either <50 copies/mL in guidelines from the United Kingdom to <1000 copies/ mL in guidelines from the United States) 12,13 unless there is an obstetric indication for a Caesarean section.…”

Section: Management During Pregnancymentioning

confidence: 99%

HIV in pregnant women and prevention of perinatal transmission

Giles¹

2015

Microbiol. Aust.

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Women with HIV who have access to treatment can expect to have a normal life expectancy. With effective antiretroviral therapy, an undetectable viral load, and avoidance of breastfeeding, the rate of perinatal transmission is extremely low (<1%). A Caesarean section is no longer routinely recommended nor is intrapartum zidovudine. Women living with HIV should be supported in their decision regarding parenthood given their excellent prognosis, low risk of perinatal transmission and reproductive rights. If interventions to reduce perinatal HIV transmission during pregnancy and post-partum are embraced, women can expect to have an uninfected infant.

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“…A comprehensive analysis of 4,717 deliveries between 2000 and 2010 among HIV infected women on successful antiretroviral therapy in the French Perinatal Cohort found the MTCT rate did not differ by mode of delivery at ≥ 37 weeks gestation [64]. Rates of elective Csections declined from 57 % to 26 % over the course of the study with a stable rate of non-elective caesareans.…”

Section: Treatment Surgerymentioning

confidence: 97%

HIV and Pregnancy

Vogler

2014

Curr Treat Options Infect Dis

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Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010

Cited by 68 publications

References 44 publications

Complications of cesarean deliveries among HIV-infected women in the United States

Complications of cesarean deliveries among HIV-infected women in the United States

HIV in pregnant women and prevention of perinatal transmission

HIV and Pregnancy

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