Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT?

Authors: Lyson Tenthani, Joep J. van Oosterhout, Andreas D. Haas, Malango Msukwa, Nozgechi Phiri, Frank Chimbwandira, Kali Tal, Karoline Aebi-Popp, Janne Estill, Olivia Keiser

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

Caesarean section (CS) is not recommended for PMTCT in Malawi HIV Guidelines, contrary to most high-income countries where CS is indicated if viral suppression is sub-optimal pre-delivery. We describe patterns of CS in HIV-infected and uninfected women in Malawi and explored if insight into the use of Elective CS (ECS) for PMTCT could be obtained.

Methods

We used routinely collected data from individual medical records from 17 large health facilities in the central and southern regions of Malawi, from January 2010 to December 2013. We included data from maternity registers from all HIV-positive women, and randomly selected around every fourth woman with negative or unknown HIV status. We used multivariable logistic regressions and cluster-based robust standard errors to examine independent associations of patient- and facility characteristics with CS and ECS.

Results

We included 62,033 women in the analysis. The weighted percentage of women who had a spontaneous vaginal delivery was 80.0% (CI 95% 79.5–80.4%); 2.4% (95% CI 2.3–2.6%) had a vacuum extraction; 2.3% (95% CI 2.2–2.5%) had a vaginal breech delivery; 14.0% (95% CI 13.6–14.4%) had a CS while for 1.3% (95% CI 1.2–1.4%) the mode of delivery was not recorded. Prevalence of CS without recorded medical or obstetric indication (ECS) was 5.1%, (n = 3152). Presence of maternal and infant complications and older age were independently associated with CS delivery. HIV-positive women were less likely to have ECS than HIV negative women (aOR 0.65; 95%-CI 0.57–0.74). Among HIV-positive women, those on antiretrovirals (ARV’s) for ≥4 weeks prior to delivery were less likely to have ECS than HIV-positive women who had not received ARVs during pregnancy (aOR 0.81; 95% CI 0.68–0.96).

Conclusions

The pattern of CS’s in Malawi is largely determined by maternal and infant complications. Positive HIV status was negatively associated with CS delivery, possibly because health care workers were concerned about the risk of occupational HIV transmission and the known increased risk of post-operative complications. Our results leave open the possibility that CS is practiced to prevent MTCT given that ECS was more common among women at high risk of MTCT due to no or short exposure to ARV’s.
Appendix
Available only for authorised users
Literature
1.
2.
De Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA. 2000;283(9):1175–82.CrossRefPubMed
3.
4.
Schouten EJ, Jahn A, Midiani D, Makombe SD, Mnthambala A, Chirwa Z, et al. Prevention of mother-to-child transmission of HIV and the health-related millennium development goals: time for a public health approach. Lancet. 2011;378(9787):282–4.CrossRefPubMed
5.
WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: what’s new. 2015.
6.
CDC. Impact of an innovative approach to prevent mother-to-child transmission of HIV–Malawi, July 2011-September 2012. MMWR Morb Mortal Wkly Rep. 2013;1(62):148–51.
7.
Tenthani L, Haas AD, Egger M, Van Oosterhout JJ, Jahn A, Chimbwandira F, et al. Brief report: HIV testing among pregnant women who attend antenatal Care in Malawi. J Acquir Immune Defic Syndr. 2015;69(5):610–4.CrossRefPubMedPubMedCentral
8.
Haas AD, Tenthani L, Msukwa MT, Tal K, Jahn A, Gadabu OJ, et al. Retention in care during the first 3 years of antiretroviral therapy for women in Malawi's option B+ programme: an observational cohort study. Lancet HIV. 2016;3(4):e175–82.CrossRefPubMedPubMedCentral
9.
Tenthani L, Haas AD, Tweya H, Jahn A, van Oosterhout JJ, Chimbwandira F, et al. Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi. J Acquir Immune Defic Syndr. 2015;69(5):610–4.CrossRefPubMedPubMedCentral
10.
Haas AD, Msukwa MT, Egger M, Tenthani L, Tweya H, Jahn A, et al. Adherence to antiretroviral therapy during and after pregnancy: cohort study on women receiving Care in Malawi's "option B+" programme. Clin. Infect Dis. 2016;63(9):1227–35.
11.
Ministry of Health Malawi. Integrated HIV Program Report January–March 2016.
12.
13.
European Mode of Delivery C. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999;353(9158):1035–9
14.
15.
de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, et al. British HIV association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med. 2014;15(Suppl 4):1–77.
16.
17.
18.
19.
WHO. Caesarean sections should only be performed when medically necessary. Switzerland: Geneva; 2015.
20.
21.
Macro. National Statistical Office. Calverton, Maryland: Malawi Demographic and Health Survey 2004; 2005.
22.
Macro National Stastical Office. Malawi demographic and health survey 2010. Malawi, and Calverton, Maryland, USA: Zomba; 2011.
23.
Chu K, Cortier H, Maldonado F, Mashant T, Ford N, Trelles M. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One. 2012;7(9):e44484.CrossRefPubMedPubMedCentral
24.
Carolan M. Maternal age >/=45 years and maternal and perinatal outcomes: a review of the evidence. Midwifery. 2013;29(5):479–89.CrossRefPubMed
25.
Carolan M, Frankowska D. Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery. 2011;27(6):793–801.CrossRefPubMed
26.
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal age and risk of labor and delivery complications. Matern Child Health J. 2015;19(6):1202–11.CrossRefPubMedPubMedCentral
27.
Aebi-Popp K, Mulcahy F, Glass TR, Rudin C, Martinez de Tejada B, Bertisch B, et al. Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery. J Acquir Immune Defic Syndr. 2013;64(1):58–65.CrossRefPubMed
28.
Ferrero S, Bentivoglio G. Post-operative complications after caesarean section in HIV-infected women. Arch Gynecol Obstet. 2003;268(4):268–73.CrossRefPubMed
29.
Kourtis AP, Ellington S, Pazol K, Flowers L, Haddad L, Jamieson DJ. Complications of cesarean deliveries among HIV-infected women in the United States. AIDS. 2014;28(17):2609–18.CrossRefPubMedPubMedCentral
30.
Read JS, Tuomala R, Kpamegan E, Zorrilla C, Landesman S, Brown G, et al. Mode of delivery and postpartum morbidity among HIV-infected women: the women and infants transmission study. J Acquir Immune Defic Syndr. 2001;26(3):236–45.CrossRefPubMed
31.
Gounden YP, Moodley J. Exposure to human immunodeficiency virus among healthcare workers in South Africa. International journal of gynaecology and obstetrics: the official organ of the. Int J Gynaecol Obstet. 2000;69(3):265–70.CrossRefPubMed
32.
Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved south Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open. 2014;4(12):e005982.CrossRefPubMedPubMedCentral
33.
Haas AD, van Oosterhout JJ, Tenthani L, Jahn A, Zwahlen M, Msukwa MT, et al. HIV transmission and retention in care among HIV-exposed children enrolled in Malawi’s prevention of mother-to-child transmission programme. J Int AIDS Soc. 2017;20(1):21947.CrossRefPubMedPubMedCentral
34.
Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18588.CrossRefPubMedPubMedCentral
35.
Kennedy CE, Yeh PT, Pandey S, Betran AP, Narasimhan M. Elective cesarean section for women living with HIV: a systematic review of risks and benefits. AIDS. 2017;31(11):1579–91.CrossRefPubMedPubMedCentral
36.
Bobat R, Coovadia H, Coutsoudis A, Moodley D. Determinants of mother-to-child transmission of human immunodeficiency virus type 1 infection in a cohort from Durban, South Africa. Pediatr Infect Dis J. 1996;15(7):604–10.CrossRefPubMed
37.
IlohI KK, IlohI ON, IkefunaI AN, IbeziakoI NS, UbesieII AC, Emodi IJ. Determinants of mother-to-child transmission of HIV despite PMTCT interventions in Enugu, Nigeria. S Afr J Child Health. 2015;9(2):49–52.
38.
Unger JA, Richardson BA, Otieno PA, Farquhar C, Wamalwa D, John-Stewart GC. Mode of delivery and postpartum HIV-1 disease progression and mortality in a Kenyan cohort. BMC Pregnancy Childbirth. 2014;14:257.CrossRefPubMedPubMedCentral
39.
Khanal V, Karkee R, Lee AH, Binns CW. Adverse obstetric symptoms and rural-urban difference in cesarean delivery in Rupandehi district, western Nepal: a cohort study. Reprod Health. 2016;13:17.
40.
European Collaborative S, Boer K, England K, Godfried MH, Thorne C. Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe. HIV Med. 2010;11(6):368–78.
Metadata
Title
Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT?
Authors
Lyson Tenthani
Joep J. van Oosterhout
Andreas D. Haas
Malango Msukwa
Nozgechi Phiri
Frank Chimbwandira
Kali Tal
Karoline Aebi-Popp
Janne Estill
Olivia Keiser
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1722-4

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Maternal sedentary behavior during pre-pregnancy and early pregnancy and mean offspring birth size: a cohort study

Research article

Ten years of simulation-based shoulder dystocia training- impact on obstetric outcome, clinical management, staff confidence, and the pedagogical practice - a time series study

Study protocol

Preparing parents for parenthood: protocol for a randomized controlled trial of a preventative parenting intervention for expectant parents

Research article

The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis

Research article

Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics

Research article

Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS™)