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Résumé
Introduction.
HIV infection is a common disease all over the world, but particularly in Africa. In order to evaluate the materno-fetal outcome in women with HIV who gave birth by caesarean section, we conducted a cohort study over a period of two years (2011 – 2012 inclusive) at the Obstetrics and Gynaecology Unit of Yaoundé Central Hospital.
Methods.
Sampling was consecutive. We included 194 women who delivered by caesarean section. Sixty five(65) were HIV positive and 129 were HIV-negative. Patients were followed up postoperatively at day5, day8 and day12 during appointments for dressings of wounds.
Results.
The average age was 30.31 years (range: 18-45 years) in the HIV-positive group and 28.47 years (range: 11-44 years) in the HIV negative group, with no significant difference (P = 0.061). The maternal morbidity rate was 27.69% in the HIV positive group against 26.36% in the HIV negative group without any significant difference. This morbidity was dominated by endometritis (8.25%). There was no statistically significant difference between the occurrence of postoperative endometritis and HIV infection (12.30% against 6.20% p = 0114 CI: 0.471 (0.168 to 1.319). Moreover there was no association between neonatal mortality and morbidity and HIV infection.
Conclusion:
Materno-fetal morbidity and mortality were not statistically different in both groups. But special precautions should be taken because a drop in CD4 count ≤ 350/mm3 increases the rate of postoperative endometritis.
Keywords: outcome, materno-fetal, HIV, caesarean section.
Mots-clés
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- Références
- Villari P , Spino C, Chalmers TC, Lau J, Sacks HS. Cesarean section to reduce perinatal transmission of human immunodeficiency virus. A metaanalysis. Onligne J Curr Clin Trials. 1993 Jul 8; Doc N ° 74: [5107 words; 46 paragraphs].
- Watts DH, Lambert JS, Stiehm ER, Bethel J, Whitehouse J, Fowler MG et al. Complications according to mode of delivery among human immunodeficiency virus-infected women with CD4 lymphocytes counts of < or = 500/microL. Am J Obstet Gynecol 2000 Jul; 183(1):100-7.
- Urbani G, de Vries MM, Cronjé HS, Niemand I, Bam RH, Beyer E. Complications associated with cesarean section in HIV-infected patients. Int J obstet gynecol. 2001; 74(1):9-15.
- Semprini AE, Castagna C, Ravizza M, et al. The incidence of complications after cesarean in 156 HIV-positive women. AIDS. 1995;9(8):913–917.
- Vimercati A, Greco P, Loverro G, et al. Maternal complications after cesarean section in HIV infected women. Eur J Obstet gynecol and Reproductive Biology. 2000; 90(1):73–76.
- Grubert TA, Reindell D, Kastner R, et al. Complications after cesarean section in HIV-1-infected women not taking anti-retroviral treatment. The Lancet. 1999; 354(9190):1612–1613.
- Duarte G, Read JS, Gonin R, Freimanis L, Ivalo S, Melo VH et al. Mode of delivery and postpartum morbidity in Latin American and Caribbean countries among women who are infected with human immunodeficiency virus-1: the NICHD International Site Development Initiative (NISDI) Perinatal Study. Am J Obstet Gynecol. 2006 Jul; 195(1):215-29. Epub 2006 May 3.
- Cavasin H, Dola T, Uribe O, Biswas M, Do M, Bhuiyan A et al. Postoperative infectious morbidities of cesarean delivery in human immunodeficiency virus-infected women. Infect Dis Obstet Gynecol. ;2009:827405. Epub 2009 May 25.
- Mbu RE, Mbopi-Keou F X, Tonye RN, Ako SN, Nana PN, Eteki NT et al. Prévalence de l’infection à VIH parmi les femmes qui accouchent sans connaitre leur statut sérologique au VIH à Yaoundé, Cameroun. Sidanet. 2007 janv 12; 4(1): 971
- Maiques-Montesinos V, Cervera-Sanchez J, Bellver-Pradas J, Abad-Carrascosa A, Serra-Serra V. Post-cesarean section morbidity in HIV-positive women. Acta Obstetricia et Gynecologica Scandinavica. 1999;78(9):789–792
- Dominguez KL, Lindegren ML, D'Almada PJ, Peters VB, Frederick T, Rakusan TA et al. Increasing trend of Cesarean deliveries in HIV-infected women in the United States from 1994 to 2000. J Acquir Immune Defic Syndr. 2003 Jun 1;33(2):232-8.
##journal.references##
Références
Villari P , Spino C, Chalmers TC, Lau J, Sacks HS. Cesarean section to reduce perinatal transmission of human immunodeficiency virus. A metaanalysis. Onligne J Curr Clin Trials. 1993 Jul 8; Doc N ° 74: [5107 words; 46 paragraphs].
Watts DH, Lambert JS, Stiehm ER, Bethel J, Whitehouse J, Fowler MG et al. Complications according to mode of delivery among human immunodeficiency virus-infected women with CD4 lymphocytes counts of < or = 500/microL. Am J Obstet Gynecol 2000 Jul; 183(1):100-7.
Urbani G, de Vries MM, Cronjé HS, Niemand I, Bam RH, Beyer E. Complications associated with cesarean section in HIV-infected patients. Int J obstet gynecol. 2001; 74(1):9-15.
Semprini AE, Castagna C, Ravizza M, et al. The incidence of complications after cesarean in 156 HIV-positive women. AIDS. 1995;9(8):913–917.
Vimercati A, Greco P, Loverro G, et al. Maternal complications after cesarean section in HIV infected women. Eur J Obstet gynecol and Reproductive Biology. 2000; 90(1):73–76.
Grubert TA, Reindell D, Kastner R, et al. Complications after cesarean section in HIV-1-infected women not taking anti-retroviral treatment. The Lancet. 1999; 354(9190):1612–1613.
Duarte G, Read JS, Gonin R, Freimanis L, Ivalo S, Melo VH et al. Mode of delivery and postpartum morbidity in Latin American and Caribbean countries among women who are infected with human immunodeficiency virus-1: the NICHD International Site Development Initiative (NISDI) Perinatal Study. Am J Obstet Gynecol. 2006 Jul; 195(1):215-29. Epub 2006 May 3.
Cavasin H, Dola T, Uribe O, Biswas M, Do M, Bhuiyan A et al. Postoperative infectious morbidities of cesarean delivery in human immunodeficiency virus-infected women. Infect Dis Obstet Gynecol. ;2009:827405. Epub 2009 May 25.
Mbu RE, Mbopi-Keou F X, Tonye RN, Ako SN, Nana PN, Eteki NT et al. Prévalence de l’infection à VIH parmi les femmes qui accouchent sans connaitre leur statut sérologique au VIH à Yaoundé, Cameroun. Sidanet. 2007 janv 12; 4(1): 971
Maiques-Montesinos V, Cervera-Sanchez J, Bellver-Pradas J, Abad-Carrascosa A, Serra-Serra V. Post-cesarean section morbidity in HIV-positive women. Acta Obstetricia et Gynecologica Scandinavica. 1999;78(9):789–792
Dominguez KL, Lindegren ML, D'Almada PJ, Peters VB, Frederick T, Rakusan TA et al. Increasing trend of Cesarean deliveries in HIV-infected women in the United States from 1994 to 2000. J Acquir Immune Defic Syndr. 2003 Jun 1;33(2):232-8.