AIDS and pregnancy: women with HIV have an increased risk of postpartum complications

Women infected with the AIDS virus (HIV) have an increased risk of postpartum complications, regardless of the type of delivery, say European researchers in the journal "AIDS."
To avoid the risk of vertical transmission of HIV, a cesarean section is recommended in women infected. But it was suggested that the effectiveness of highly active (HAART) on the decrease in viral load in the mother may reduce the benefit of a systematic caesarean section, in terms of side effects of this intervention compared to delivery by vaginally.

For the debate on the value of a systematic cesarean among women with HIV, HIV study group on European obstetrics, coordinated by Dr. Simona Fiore Institute on Child Health in London, therefore assessed the frequency of clinical events in the immediate post-partum women who gave birth in 13 European maternity.

The researchers included data from two controlled studies (vaginal deliveries and caesarean section) from infected patients, compared with uninfected women (control group).

Of the 816 births analyzed, the complication rate has reached 29.2% (119 of 408) in HIV-positive patients, 19.4% (79 of 408) among HIV-negative women, 42.7% (135 of 316) in cesarean section women and 12.6% (63 of 500) among those who delivered vaginally.

The authors found no major complications among women who delivered vaginally, but compared to seronegative controls, HIV + women showed an increased risk (4.5 times) of puerperal fever (or the waning of birth ) occurred mainly after an episiotomy.

Women delivered by cesarean section, six cases of major complications were identified, five HIV-infected women. In this group, the risk of major complications fivefold and the risk of minor complications (mainly anemia) is multiplied by 1.51 compared to controls.

"This study not only shows that the strategy of planned caesarean section does not appear to increase the risk of severe maternal morbidity, but that vaginal delivery is not without risk for HIV + women," the authors conclude.

The latter therefore propose to adopt measures to reduce the risk of infection among women delivering vaginally using a prophylactic antibiotic treatment. In cesarean section patients, they suggest a prescription for prenatal iron to reduce the risk of anemia.

Finally, they believe that HIV-positive pregnant women should receive more complete information on the management of risk of vertical transmission and postpartum complications. They also advise to associate more closely with clinical decisions regarding the type of delivery.