HIV-positive women have more post-birth complications, even if they have a vaginal delivery

HIV-positive women having either a managed caesarean delivery or a managed vaginal birth are more likely to experience a post-delivery complication than HIV-negative women, according to a paper published in the April edition of AIDS. Although the incidence of complications was lower amongst women having a vaginal delivery, the study authors recommend that HIV-positive women be counselled that both vaginal and caesarean delivery methods have risks. They also recommend healthcare providers take action to reduce the risks of post-delivery complications in HIV-infected women.

Elective caesarean section delivery reduces the risk of mother-to-baby transmission of HIV. However, there are risks of post-delivery complications following a caesarean section and it has been suggested that the these risks might outweigh the benefits for HIV-positive women with low viral loads.

To gain a better understanding of the safety of elective caesarean delivery in HIV-positive women, investigators from the European Collaborative Study collected prospective from 13 sites across Europe on the frequency of major and minor post-partum complications. Two case controlled studies were used (using matched HIV-positive women and HIV-negative controls), one looking at managed vaginal delivery, and one at elective caesarean delivery. Investigators compared the frequency of both major and minor post-partum complications in HIV-positive women giving birth naturally or by caesarean intervention. The investigators also compared the frequency of complications in HIV-positive and HIV-negative women.

Overall, HIV-positive women were significantly more likely to have a post-partum complication than HIV-negative women (29% versus 19%, p

The investigators also found that there were more complications amongst HIV-positive women having caesarean deliveries compared to HIV infected women having a vaginal birth (42.7% versus 12.6%, p=0.001). Most of these complications were however, minor.

There were a total of five major post-partum complications in HIV infected women having a caesarean delivery and none in women having a managed vaginal delivery. However, the investigators found that the five-fold increased risk of complications after a caesarean was also present for HIV-negative women.

Amongst HIV-positive women having a caesarean delivery, anaemia not requiring a blood transfusion was the most frequently reported minor complication (64 instances). This was associated with excessive blood loss during surgery (odds ratio 2.7), antenatal antiretroviral therapy (OR 3.10), and immunosuppression (OR 2.9).

There were no major complications in either HIV-positive or HIV-negative women having a managed vaginal delivery. HIV-positive women had, however, a significantly increased risk of post-partum fever than HIV-negative women (OR 4.5, p=0.001), and HIV-positive women undergoing episiotomy (an incision into the area of skin between the vagina and the anus) had an increased risk of puerperal fever (p=0.001).

The investigators conclude that their study not only shows "that a strategy of elective caesarean section for HIV infected women in Europe does not appear to increase the risk of serious maternal morbidity but also that vaginal delivery in infected women is not risk free." They add that their results suggest that it is important to introduce strategies to reduce the risk of post-partum infections, particularly after vaginal delivery, and for anaemia after caesarean section. The use of antibiotics, iron supplementation and spinal anaesthetic, which is associated with reduced blood loss, would be good places to start, the investigators suggest.

Further information on this website

Optionsduring pregnancy - Mode of delivery overview