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Calvet, Guilherme 1 ; Joao, Esau 1* ; Cunha, Cynthia 1 ; Silva, Raulino 1 ; Sidi, Leon 1 ; Silva, Sonia 1 ; Medeiros, Adriana 1 ; Martins, Ezequias 1 ;

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Presentation on theme: "Calvet, Guilherme 1 ; Joao, Esau 1* ; Cunha, Cynthia 1 ; Silva, Raulino 1 ; Sidi, Leon 1 ; Silva, Sonia 1 ; Medeiros, Adriana 1 ; Martins, Ezequias 1 ;"— Presentation transcript:

1 Calvet, Guilherme 1 ; Joao, Esau 1* ; Cunha, Cynthia 1 ; Silva, Raulino 1 ; Sidi, Leon 1 ; Silva, Sonia 1 ; Medeiros, Adriana 1 ; Martins, Ezequias 1 ; Menezes, Jacqueline 1 1-Infectious Diseases Department, Hospital dos Servidores do Estado, Rio de Janeiro. Risk factors for postpartum complications among HIV-infected women in Rio de Janeiro, Brazil Corresponding Author: Guilherme A Calvet, MD Hospital dos Servidores do Estado Infectious Diseases Department Rua Sacadura Cabral 178, 4º andar – anexo IV - Pesquisa Clínica – DIP - Rio de Janeiro – RJ – Brazil CEP: E- Fax: Tel: #TUPEB115 Background/Objectives Several risk factors for postpartum morbidity were described in the literature including duration of labour and prolonged rupture of membranes, maternal age, obesity, socioeconomic status, immunosuppression, lack of prenatal care, non-elective cesarean delivery, experience of the surgeon and type of anaesthesia. Several studies in HIV infected women suggests that elective C-section performed before labor or rupture of membranes has a greater morbidity than vaginal delivery. Infection represents the greatest portion of this morbidity, with wound infections, endometritis and urinary tract infection the most frequent causes of morbidity in this population. The objective of this study was to to determine which factors are associated with the occurrence of postpartum complications in a cohort of HIV-infected women. Methods Study Population and Statistical Analyses: Retrospective study from an observational cohort of 969 HIV-infected pregnant women followed at Hospital dos Servidores do Estado, Rio de Janeiro, Brazil. Inclusion criteria: 1) HIV-infected pregnant women at any gestational age with at least one prenatal visit and use of antiretroviral therapy who delivered between January 1, 1996 and December 31, Exclusion criteria: 1) HIV-infected pregnant women without prenatal care or who were identified at delivery and did not receive antiretroviral therapy. 2) Women who received only intrapartum zidovudine. 3) Spontaneuos abortions, women lost to follow up before delivey and maternal death. Medical charts of all women fitting the above criteria were reviewed anonymously without patient identifiers. The study was approved by the Research Ethics Committee of the Hospital dos Servidores do Estado. Some women delivered more than one baby in different pregnancies. Dependent Variable: Postpartum complications (yes/no) Covariates: 1) Maternal age: discrete and categoric: years, years, >35 years 2) Race/ethnicity:White, black, mixed/mulatto 3) Years of formal education: discrete Family income: discrete and categoric: 1 Brazilian month salary/wage 4) Parity: discrete and categoric: nulliparity, primiparity and multiparity 5) Alcohol use during pregnancy: yes/no 6) Smoking during pregnancy: yes/no 7) Illicit drug abuse during pregnancy: yes/no 8) Sexually transmitted diseases: yes/no 9) Hypertensive disorders: yes/no 10) Bacterial vaginosis: yes/no 11) Urinary tract infection during pregnancy: yes/no 12) Anemia: yes/no 13) CDC category: A,B and C 14) CD4 cell count: continuous and categoric: 0-199; ; ≥500 cells/mm 3 15) Viral load at delivery: continuous and categoric: 10,000 copies/mL 16) Type of ART: Mono/dual nucleoside, HAART with NNRTI, HAART with PI 17) Mode of delivery: Elective C-section (ECS), non-scheduled C-section after labor and/or rupture of membranes (NECS), vaginal delivery (VD) 18) Time of rupture of membranes: <4 hours ; ≥ 4 hours 19) Gestational age at delivery: continuous and categoric: 36 weeks Postpartum complications among HIV-infected women were similar in frequency to those reported in the literature. Wound infections and endometritis were the most frequent causes of morbidity in this population. Postpartum complications were highest after emergency, rather than elective cesarean or vaginal delivery. This retrospective study suggests that additional risks factors may contribute for postpartum complications. Mode of delivery and frequency of postpartum complications: Non-scheduled C-section after labor and/or rupture of membranes: 18.5% (28/151) Elective C-section:15.4% (64/416) Vaginal delivery: 8.9% (28/315) A statistically significant univariate association with postpartum complications and the following variables was detected: Alcohol use (p<0.05) Hypertensive disorders (p<0.05) Urinary tract infection (p<0.05) Preterm delivery (p<0.005) Mode of delivery (p<0.05) Table 1- Frequency of Postpartum morbidities Conclusions Data from 894 pregnant women were analyzed. Overall incidence of PC was 13.9%. More than 1 complication occurred in 14 cases. Table 1 shows the frequency of postpartum complications. Associations of predictors with the outcome were evaluated using chi-squared test, Fisher exact test, analysis of variance and Kruskal-Wallis median test. All the analyses were performed by SPSS version 12.0 and R Observations: Blood transfusion was required in 6 women with hemorrhage. Total hysterectomy was performed in one patient and subtotal hysterectomy in two patients following uterine atony. Results


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