Obstetric haemorrhage-related severe maternal outcomes in HIV-infected women
Date
2018
Authors
Antwi, Kwadwo Atobra
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Abstract
There is paucity of data on the contribution of HIV infection to obstetric haemorrhage-related severe maternal outcomes (SMO) with some literature suggesting an increased risk in HIV-infected women. Since the leading causes of maternal mortality in South Africa are non-pregnancy related infections, mainly HIV-related, and obstetric haemorrhage, there is a possible relationship between HIV infection and obstetric haemorrhage-related SMO. Hence the aim of this study was to determine whether obstetric haemorrhage-related SMO are increased in HIV-infected women.
A retrospective study of cases of obstetric haemorrhage-related SMO at Chris Hani Baragwanath Academic Hospital, from January to December 2015 was conducted. A total of 73 women had obstetric haemorrhage-related SMO. Of these, 18 (24.7%) women were HIV-infected and 50 (68.5%) uninfected. All the HIV-infected women were on antiretroviral therapy, 50% initiated pre-pregnancy, and the median CD4 count was 409 cells/mm3. There were 65 near-misses, 49 (72.1%) in HIV-infected women, and there were three maternal deaths, two in HIV-infected women.
Previous caesarean section was the commonest identifiable factor associated with obstetric haemorrhage, 6/18 (33.3%) in HIV-infected women and 9/50 (18.0%) in uninfected women. The commonest cause of haemorrhage was postpartum haemorrhage, diagnosed in 65/68 (95.6%) women, and there was no significant difference between HIV-infected and uninfected women. There were no significant differences in the medical and surgical interventions the patients needed.
Obstetric haemorrhage-related SMO were not increased in HIV-infected women in this study likely because it was a relatively healthy population of HIV-infected women. Larger studies are needed to elucidate these findings.