Investigate complications of cesarean section in a cohort of HIV-infected pregnant women.
IMPAACT P1025 is a prospective cohort study of HIV-1-infected women and infants, enrolled 2002 to 2013, at clinical sites in the United States and Puerto Rico. Demographic, medical, and obstetric data were collected and analyzed including cesareans indications. Delivery route was categorized as elective cesarean (ECS, before labor and <5 minutes before membrane rupture), non-elective cesarean (NECS, all other cesareans) or vaginal delivery. Logistic regression models evaluated associations between delivery route and maternal intrapartum/postpartum morbidities. Composite morbidity of vaginal delivery was compared to ECS and NECS. RESULTS
This study included 2297 women. 99% used antiretroviral medication and 89% were on a combination antiretroviral therapy regimen. 84% had a HIV-1 viral load ≤400 copies/mL before delivery. 46% (1055) delivered vaginally, 35% (798) by ECS, and 19% (444) by NECS. While interruption of HIV-1 infection was the second most frequent indication for cesarean after repeat cesarean, it decreased as an indication over time. There were no delivery-related maternal mortalities. Overall 19% of women had >1 complication(s) – primarily wound complications (14%) or other infections (11%). Vaginal delivery had the lowest complication rate (13%), followed by ECS (23%), and highest NECS (28%) with an overall p<0.001. HIV-1 mother-to-child transmission rates were low and did not differ by delivery mode group. CONCLUSIONS
HIV interruption as cesarean indicator declined during the study. Morbidity was more common in HIV-infected women delivering by NECS than ECS and lowest with vaginal delivery.
CLINICAL TRIAL REGISTRATION
Prenatal and Postnatal Studies of Interventions for Prevention of Mother-To-Child Transmission https://clinicaltrials.gov/ct2/show/NCT00028145?term=impaact+1025&rank=2 NCT00028145.