The effect of maternal HIV infection on maternal conditions and perinatal deaths in southwest Tshwane

AIM To describe the effect of HIV infection on maternal and perinatal disease in south west Tshwane. SETTING Southwest Tshwane has a low to low-middle income urban population and is served by Pretoria West and Laudium Midwife-Obstetric Units (MOUs) and Kalafong Hospital and fourteen primary care clinics which refer to those institutions. These are all public health institutions. METHODS Only data from women from southwest Tshwane between 1 January 2006 and 30 September 2008 was used in the study. As part of routine audit, the maternal HIV status was recorded as well as major maternal antenatal and -intrapartum complications. All perinatal deaths along with their HIV status were recorded in the Perinatal Problem Identification Programme (PPIP) and the primary obstetric cause and final neonatal cause of deaths. The causes of perinatal deaths from HIV infected, negative and unknown were analysed. RESULTS There were 17184 births in southwest Tshwane in the time period analysed, of which mothers (86.1%) were counselled and (81.9%) were tested, and of these 21.5% HIV infected. The incidence of hypertension in the HIV infected women was 3.2% significantly lower than the 5.0% in the HIV negative group (OR 0.63, 95% CI 0.50, 0.79). There was a trend to more HIV infected women had a PPH (OR 1.21, 95% CI 0.99, 1.47). The overall caesarean section rate was 28.3% with significantly more HIV infected women having both elective and emergency caesarean sections (OR 1.21, 95% CI 1.10, 1.31). The perinatal mortality rate was 33.8/1000 births (> 500 g) in the HIV infected group and 26.1/1000 births in the HIV negative group (OR 1.30, 95% CI 1.03, 1.65) mainly due to the increased neonatal death rate. The low birth weight (LBW) rate for HIV infected women was 19.8% compared with 14.3% with HIV negative women (p < 0.0000); OR1.47, 95% CI 1.32, 1.64). There significantly more perinatal deaths due to spontaneous preterm birth, infection and intrapartum asphyxia in the HIV infected mothers. CONCLUSION In southwest Tshwane a HIV infected mother has a decreased risk of hypertension, a trend towards increased postpartum haemorrhage and a thirty percent increased risk of having a perinatal death compared to an HIV negative mother, this is due mainly to spontaneous preterm birth, infections and intrapartum asphyxia.