A comparative study of complications in HIV-infected and HIV-Uninfected women undergoing caesarean section at the University Teaching Hospital,Lusaka,Zambia

Background: There is scientific evidence in support of the benefit of caesarean section for the prevention of mother to child transmission of HIV (PMTCT). However, information on the extent of complications and maternal mortality associated with caesarean section in HIV infected women in low resource settings such as at UTH is lacking. Some studies have reported increased risk of maternal complications associated with caesarean section in HIV infected women (particularly sepsis). This study is therefore designed to explore the incidence of maternal complications associated with caesarean section at UTH and compare complications in HIV infected and HIV uninfected women.
Objective: To document the incidence of complications in women undergoing caesarean section at UTH and compare them in HIV infected women and HIV uninfected.
Design and setting: A prospective cohort study documenting complications in women undergoing caesarean section at UTH in Lusaka. In October 2010, 299 consecutive patients undergoing caesarean section at UTH with known HIV status were recruited.
Methods: Consenting participants were followed up for six weeks after the caesarean section. Participants were interviewed and any complications documented. Infectious maternal morbidity such as wound sepsis, endometritis and puerperal pyrexia was the main outcome measure. Analysis was by Chi square and logistic regression. Significance was set at p<.05.
Results: Fifty eight (19.4%) HIV positive and 241 (80.6%) HIV negative women were recruited. Apart from age and parity, there were no statistically significant differences between the two groups - HIV negative women were younger and more were nulliparous. Overall 27 (9%) women had sepsis (6 were HIV positive and 21 were HIV negative - 10.3 vs. 8.7% respectively). The unadjusted odds ratio for sepsis in HIV positive vs. HIV negative women was 1.21 (95% Cl .46-3.15), p=.682 (non¬significant). Adjusting for potential confounders for the association between HIV and sepsis (based anecdotally) into a logistic regression model, (and which included: age; whether emergency or elective caesarean; single or multiple skin preparation used; separate blade used for deeper tissues or not; use of pre-operative antibiotics; blood loss greater than 1000ml; duration of operation >45 minutes) did not significantly alter the odds ratio for sepsis in HIV positive vs. HIV negative women -adjusted OR=1.39 (95%CI .5-3.59) p= .524.
Conclusion: Sepsis complicates approximately a tenth of caesarean sections though this complication is not independently associated with HIV status. Further studies are needed to address which factors contribute to post-caesarean complications.