Term labor management and outcomes in treated HIV-infected women without contraindications to vaginal delivery and matched controls

Abstract 

Objective

To assess labor management and outcomes for treated HIV-infected pregnant women with no obstetric or virologic contraindications to vaginal delivery.

Method

A retrospective case-control study was conducted at a single center with 146 treated HIV-infected pregnant women without obstetric or virologic contraindications to vaginal delivery and 146 controls. Cases and controls were matched for parity, previous cesarean delivery, and geographic origin.

Results

The mode of delivery was similar in the 2 groups but the episiotomy rate was significantly lower among the HIV-infected women (29.6% vs 45.6%, P=0.01), with no difference in mean birth weight, simple or complex perineal laceration rates or neonatal outcome. Postpartum morbidity was also similar for controls and HIV-infected women with a CD4⁺ cell count of 200 cells/mL or higher. However, in the study group, postpartum morbidity was higher among those whose CD4⁺ cell count was lower than this threshold (3.2% vs 22.2%, P=0.007). No case of mother-to-child transmission of HIV occurred.

Conclusion

HIV-infected women with no contraindication to vaginal delivery seem to have the same labor outcomes as uninfected women.

Keywords: Cesarean delivery, HIV, Labor management, Pregnancy, Prevention of mother-to-child HIV transmission