{
    "abstract": "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.\nStudies 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.\nThe 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.",
    "authors": [
        {
            "affiliation": "Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.",
            "firstname": "Clara",
            "initials": "C",
            "lastname": "Calvert"
        },
        {
            "affiliation": null,
            "firstname": "Carine",
            "initials": "C",
            "lastname": "Ronsmans"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1371/journal.pone.0074848",
    "journal": "PloS one",
    "keywords": [],
    "methods": null,
    "publication_date": "2013-10-15",
    "pubmed_id": "24124458\n20569827\n14711759\n8953667\n7594657\n9746374\n7630253\n17273360\n18811779\n7786990\n16327320\n20675036\n10535342\n20691445\n12387967\n10560681\n17305888\n7576327\n19733286\n16954723\n17485809\n2240112\n19503828\n17666615\n11349171\n11142830\n20107679\n15541864\n2261113\n17313505\n7907777\n9103689\n9583605\n2059369\n18557248\n15479503\n19629507\n17464809\n18393018\n20353124\n12676387\n16684169\n15291993\n16806653\n11430935\n18628535\n11226443\n14712975\n15060441\n19716560\n20375891\n1595015\n8106728\n1348479\n2158338\n11914001\n10099139\n23435296\n17997391\n23741771\n26180894\n23351797\n11197413\n18679152",
    "results": null,
    "title": "HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.",
    "xml": "<Element 'PubmedArticle' at 0x788503cd5760>"
}