Determinants of postpartum infectious complications among HIV uninfected and antiretroviral naïve-HIV infected women following vaginal delivery: a prospective cohort study.

ABSTRACT

OBJECTIVE: To determine the incidence rate of postpartum infectious morbidity among HIV uninfected women compared to antiretroviral naïve-HIV infected women who were eligible for vaginal delivery. STUDY DESIGN: A nested study was conducted within a large prospective trial in which HIV infected women eligible for vaginal delivery at term were compared with HIV uninfected women. Women were reviewed within 72 h post delivery, at 1, 2 and 6 weeks for clinical signs of puerperal infection. RESULTS: 241 HIV infected women were compared with 427 HIV uninfected controls. Both groups were comparable in terms of baseline parameters. The infectious morbidity rate was similar between the HIV infected and uninfected women (p=0.977). Factors which significantly increased puerperal infections in both groups were the presence of an episiotomy, p<0.001, the number of vaginal examinations after rupture of amniotic membranes, p=0.026, and a CD4 count of <200 micro/L, p=0.017 in the HIV infected group. CONCLUSION: There was no difference in postpartum infections amongst HIV infected compared to uninfected women, but an episiotomy was associated with a 2-fold increased risk of infectious morbidity.