Read J S, Tuomala R, Kpamegan E, Zorrilla C, Landesman S, Brown G, Vajaranant M, Hammill H, Thompson B
Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892-7510, USA.
J Acquir Immune Defic Syndr. 2001 Mar 1;26(3):236-45. doi: 10.1097/00042560-200103010-00005.
Cesarean delivery before onset of labor and rupture of membranes (i.e., scheduled cesarean delivery) is associated with a lower risk of vertical transmission of HIV. The following a priori hypotheses were tested: among HIV-infected women, scheduled cesarean delivery is associated with a higher risk of postpartum morbidity, longer hospitalization, and a higher risk of rehospitalization than spontaneous vaginal delivery. Postpartum morbidity occurred following 178 of 1,186 (15%) of deliveries during 1990 to 1998 in The Women and Infants Transmission Study. The most commonly reported postpartum morbidity events were: fever without infection, hemorrhage or severe anemia, endometritis, urinary tract infection, and cesarean wound complications. Several time trends were observed: the median duration of ruptured membranes decreased (p < .001), intrapartum antibiotic use increased (p < .001), the median antepartum plasma HIV RNA concentration decreased (p < .001), and the incidence of any postpartum morbidity decreased (p = .02). With spontaneous vaginal delivery as the reference category, both scheduled (odds ratio [OR] = 4.69; 95% confidence interval [95% CI], 2.03-10.84), and nonscheduled (OR, 2.50; 95% CI, 1.24-5.04) cesarean deliveries were associated with fever without infection; with urinary tract infection (OR, 3.79; 95% CI 1.04-13.85; OR, 3.86; 95% CI, 1.55-9.60, respectively), and with any postpartum morbidity (OR, 3.19; 95% CI 1.69-6.00; OR, 4.10; 95% CI, 2.71-6.19, respectively). Nonscheduled cesarean deliveries were more likely to be complicated by endometritis (OR, 6.98; 95% CI, 3.53-13.78). Adjusted ORs relating mode of delivery and each of the outcomes (fever without infection, urinary tract infection, endometritis, and any postpartum morbidity) were similar to unadjusted ORs. Results of this analysis indicate scheduled cesarean delivery is associated with an increased risk of any postpartum morbidity and, specifically, postpartum fever without infection. The potential for postpartum morbidity with scheduled cesarean delivery should be considered in light of possible adverse events associated with other interventions to decrease the risk of vertical transmission of HIV. Counseling of HIV-infected pregnant women regarding scheduled cesarean delivery as a possible intervention to decrease maternal-infant transmission of HIV should include discussion of these results, as well as new data as they become available, regarding the incidence and severity of postpartum morbidity events among HIV-infected women according to mode of delivery.
在临产发动和胎膜破裂之前进行剖宫产（即择期剖宫产）与较低的HIV垂直传播风险相关。对以下先验假设进行了检验：在HIV感染的女性中，与自然阴道分娩相比，择期剖宫产与产后发病风险更高、住院时间更长以及再次住院风险更高相关。在1990年至1998年的母婴传播研究中，1186例分娩中有178例（15%）发生了产后发病。最常报告的产后发病事件为：无感染的发热、出血或严重贫血、子宫内膜炎、尿路感染以及剖宫产伤口并发症。观察到了几种时间趋势：胎膜破裂的中位持续时间缩短（p <.001）、产时抗生素使用增加（p <.001）、产前血浆HIV RNA浓度中位数下降（p <.001）以及任何产后发病的发生率下降（p =.02）。以自然阴道分娩作为对照类别，择期剖宫产（优势比[OR] = 4.69；95%置信区间[95%CI]，2.03 - 10.84）和非择期剖宫产（OR，2.50；95%CI，1.24 - 5.04）均与无感染的发热相关；与尿路感染（OR，3.79；95%CI 1.04 - 13.85；OR，3.86；95%CI，1.55 - 9.60）以及任何产后发病（OR，3.19；95%CI 1.69 - 6.00；OR，4.10；95%CI，2.71 - 6.19）相关。非择期剖宫产更易并发子宫内膜炎（OR，6.98；95%CI，3.53 - 13.78）。与分娩方式和每种结局（无感染的发热、尿路感染、子宫内膜炎以及任何产后发病）相关的调整后OR与未调整的OR相似。该分析结果表明，择期剖宫产与任何产后发病风险增加相关，尤其是无感染的产后发热。鉴于与其他降低HIV垂直传播风险的干预措施相关的可能不良事件，应考虑择期剖宫产的产后发病可能性。对于感染HIV的孕妇，在将择期剖宫产作为降低母婴HIV传播的一种可能干预措施进行咨询时，应包括对这些结果以及根据分娩方式的HIV感染女性产后发病事件的发生率和严重程度的新数据（如有）的讨论。
