revalence and factors associated with cesarean section in HIV-positive patients in a university teaching hospital – A case-control study

Abstract

INTRODUCTION: Cesarean section (CS), although a relatively safe procedure, is associated with
more risks than vaginal delivery, regardless of HIV status. Complications following CS are greater
in HIV-positive women than in HIV-negative women. This study’s objective was to determine the
prevalence and factors associated with CS in HIV-positive patients in our environment.
METHODS: A case-control study of factors associated with and outcomes of CS over 13 years was
conducted in HIV-positive and HIV-negative women at UMTH. Multinomial regression analysis
was used to determine factors independently associated with CS in HIV-positive women. Stratified
analysis was used to determine factors associated with the development of complications
following CS in HIV-positive women. A p-value <0.05 was considered statistically significant.
RESULTS: The prevalence of CS in HIV-positive women was 3.02%, with PMTCT 51.5% (53/103)
as the major indication. Compared to the control, the HIV-positive women were more likely to
have pre-operative anemia (P= 0.001) and their CS to be undertaken electively (P<0.001), under
general anesthesia (P<0.001), to last more than 60 minutes (P=0.002) and develop a postoperative
complication (77.8% vs. 22.2%). Pre-operative anemia and preterm delivery were found to be
associated with the development of a complication.
CONCLUSION: The prevalence of cesarean section in HIV-positive patients is low in our
environment. CS is also more likely to be performed electively for over 60 minutes under general
anesthesia on a nulliparous woman with no formal education and pre-operative anemia.