*Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, NC;†Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA;‡Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA;§Department of Obstetrics & Gynecology, Brigham & Women's Hospital, Harvard University School of Medicine, Boston, MA;‖Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL; and¶Department of Obstetrics & Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA.
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Objective:To investigate complications of cesarean section in a cohort of HIV-infected pregnant women.Methods:IMPAACT P1025 is a prospective cohort study of HIV-1–infected women and infants, enrolled 2002–2013, at clinical sites in the United States and Puerto Rico. Demographic, medical, and obstetric data were collected and analyzed including cesarean indications. The delivery route was categorized as elective cesarean (ECS) (before labor and <5 minutes before membrane rupture), nonelective cesarean (NECS) (all other cesareans) or vaginal delivery. Logistic regression models evaluated associations between delivery route and maternal intrapartum/postpartum morbidities. Composite morbidity of vaginal delivery was compared with ECS and NECS.Results:This study included 2297 women. Of note, 99% used antiretroviral medication and 89% were on a combination antiretroviral therapy regimen; 84% had a HIV-1 viral load ≤400 copies per milliliter before delivery; 46% (1055) delivered vaginally, 35% (798) by ECS, and 19% (444) by NECS. Although interruption of HIV-1 infection was the second most frequent indication for cesarean after repeat cesarean, it decreased as an indication over time. There were no delivery-related maternal mortalities. Overall, 19% of women had ≥1 complication(s)—primarily wound complications (14%) or other infections (11%). Vaginal delivery had the lowest complication rate (13%), followed by ECS (23%), and highest NECS (28%) with an overall P < 0.001. HIV-1 mother-to-child transmission rates were low and did not differ by delivery mode group.Conclusions:HIV interruption as cesarean indicator declined during the study. Morbidity was more common in HIV-infected women delivering by NECS than ECS and lowest with vaginal delivery.Clinical Trial Registration:Prenatal and Postnatal Studies of Interventions for Prevention of Mother-To-Child Transmission https://clinicaltrials.gov/ct2/show/NCT00028145?term=impaact+1025&rank=2 NCT00028145.