HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.

<h4>Background</h4>Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications a...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Clara Calvert, Carine Ronsmans
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e0a15e3679e7403b93b605071d50f644
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e0a15e3679e7403b93b605071d50f644
record_format	dspace
spelling	oai:doaj.org-article:e0a15e3679e7403b93b605071d50f6442021-11-18T08:52:33ZHIV and the risk of direct obstetric complications: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0074848https://doaj.org/article/e0a15e3679e7403b93b605071d50f6442013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24124458/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.<h4>Methods and findings</h4>Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent.<h4>Conclusions</h4>The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.Clara CalvertCarine RonsmansPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 10, p e74848 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Clara Calvert Carine Ronsmans HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
description	<h4>Background</h4>Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.<h4>Methods and findings</h4>Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent.<h4>Conclusions</h4>The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.
format	article
author	Clara Calvert Carine Ronsmans
author_facet	Clara Calvert Carine Ronsmans
author_sort	Clara Calvert
title	HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
title_short	HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
title_full	HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
title_fullStr	HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
title_full_unstemmed	HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.
title_sort	hiv and the risk of direct obstetric complications: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/e0a15e3679e7403b93b605071d50f644
work_keys_str_mv	AT claracalvert hivandtheriskofdirectobstetriccomplicationsasystematicreviewandmetaanalysis AT carineronsmans hivandtheriskofdirectobstetriccomplicationsasystematicreviewandmetaanalysis
_version_	1718421234008457216

HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.

Ejemplares similares