Background:  Caesarean section before labor and ruptured membranes (ECS) decreases mother-to-child transmission of HIV-1. Little information exists regarding the risk of postpartum morbidity among HIV-1-infected women in Latin America and the Caribbean. We tested the hypothesis that there is a higher risk of PPM with ECS than with vaginal delivery among HIV-1-infected women in Latin America and the Caribbean.

Methods:  We analyzed data from a prospective cohort study of HIV-1-infected women and their infants in Argentina, the Bahamas, Brazil, and Mexico (NISDI Perinatal Study). The study population consisted of women enrolled as of June 1, 2004, with known mode of delivery and with follow-up ≥ 6 to 12 weeks after delivery. Postpartum morbidity was defined as major (septic shock, pneumonia, thrombosis, endometritis, and major wound infection [dehiscence with drainage or purulent material]) and minor (febrile morbidity, urinary tract infection, hemorrhage not requiring transfusion, and minor wound infection [without dehiscence or drainage of purulent material]). The Fisher-Freeman-Halton exact test and logistic regression analysis were used.

Results:  As of June 1, 2004, 711 women were enrolled in the cohort, of whom 568 met the inclusion criteria. Vaginal delivery (n = 240) and ECS (n = 223) were most common, with fewer women delivering by cesarean section after labor or after ruptured membranes (NECS) (n = 105). Postpartum morbidity complicated 3% (n = 17) of deliveries  (10 major, 7 minor). Overall, there was no statistically significant association between mode of delivery and postpartum morbidity (vaginal 5 [2.1%]; ECS 5 [2.2%]; NECS 7 [6.7%; p = 0.07). Similarly, there was no significant association between mode of delivery and major postpartum morbidity. Analysis of minor morbidity revealed no significant difference between ECS and vaginal delivery (p = 0.61, OR = 2.2, 95% CI 0.2 to 23.9), but women with NECS were almost 10 times more likely to have minor postpartum morbidity than those who delivered vaginally (p =0.03, OR = 9.6, 95% CI 1.1 to 86.9).   

Conclusions:  The overall proportion of HIV-1-infected women with any postpartum morbidity event in this Latin American and Caribbean cohort with enrollment beginning in 2002 is much lower than described in previous studies. There was no statistically significant difference in the risk of overall or major postpartum morbidity according to mode of delivery, but NECS was associated with a greater risk of minor postpartum morbidity events compared with vaginal delivery.

Keywords: mode of delivery; postpartum morbidity; HIV-infected women