Correlation of postpartum morbidity and advanced HIV disease

SMFM Abstracts S191 677 CORRELATION OF VIRAL LOAD AND E ANTIGEN STATUS IN A U.S. COHORT OF PREGNANT WOMEN INFECTED WITH HEPATITIS B VANESSA LAIBL (F)1, JEANNE SHEFFIELD1, SCOTT ROBERTS1, DONALD MCINTIRE1, GEORGE WENDEL1, 1 University of Texas Southwestern Medical Center at Dallas, Obstetrics and Gynecology, Dallas, Texas OBJECTIVE: Hepatitis B virus (HBV) is a major health concern to both mother and fetus. In non-pregnant individuals, e antigen (HBeAg) status has been shown to correlate with HBV DNA levels. Our purpose was to determine in a U.S. cohort of pregnant women if HBeAg status is a marker for high HBV DNA levels. STUDY DESIGN: This was a retrospective review of pregnant women known to be chronic carriers of hepatitis B followed at our institution between January, 2003 and May, 2005. Demographic characteristics, HBeAg status, HBV DNA level, liver function tests, and obstetric outcomes were collected. Data were analyzed using Wilcoxon rank-sum, Pearson chi square test, and Student’s t-test. RESULTS: Data were available for 59 patients. Fourteen (25%) were HBeAg positive, and 41 (75%) were HBeAg negative. Half of the patients in the HBeAg positive group were Asian compared to only 3% in the HBeAg negative group. The patients who were HBeAg positive had significantly higher viral loads than those patients who were HBeAg negative (P!0.01). The median HBV DNA level was 2.6 ! 107 copies/ml among the HBeAg positive group, and it was below the limits of detection (!2000 copies/ml) for the HBeAg negative group. Sixty-six percent of the HBeAg negative women had HBV DNA levels below the limits of detection compared to 7% of the HBeAg positive women. The HBeAg positive group had significantly higher alanine aminotransferase (ALT) levels (P=0.04); however, there was not a significant difference in aspartate aminotransferase (AST) or serum bilirubin levels (P=0.06, 0.37). Obstetric outcomes were similar in both groups. CONCLUSION: Pregnant women who are HBeAg positive have significantly higher HBV DNA levels. These patients also have significantly higher ALT levels but similar obstetric outcomes.

679 THE MFMU CESAREAN REGISTRY: PERIOPERATIVE MORBIDITY AMONG HIV INFECTED WOMEN UNDERGOING CESAREAN DELIVERY JUDETTE LOUIS (F)1, 1 for the NICHD MFMU Network, Bethesda, Maryland OBJECTIVE: To determine if the perioperative morbidity rate is higher in HIV infected women when compared with HIV noninfected women, undergoing cesarean delivery. STUDY DESIGN: Secondary analysis of women undergoing a cesarean delivery with a single gestation whose HIV status is known. Data were collected as part of a prospective 4-year (1999-2002) observational study and analyzed using logistic regression. Postpartum morbidity was defined as endometritis, sepsis, wound complications, postpartum transfusion or death. RESULTS: Perioperative outcomes, adjusted for number of prior cesarean deliveries, are presented in the Table. After controlling for number of prior cesarean deliveries, race, drug use, prenatal care, labor, hours from rupture to delivery, chorioamnionitis and general anesthesia, patients with HIV infection were more likely to have postpartum morbidity (O.R. 1.7, 95% CI 1.3-2.3). CONCLUSION: HIV infected women undergoing cesarean delivery are at significantly increased risk for intraoperative and postpartum complications.

678 CORRELATION OF POSTPARTUM MORBIDITY AND ADVANCED HIV DISEASE JUDETTE LOUIS (F)1, MUDATHIRU BUHARI2, BERNARD GONIK1, DIANNE ALLEN1, THEODORE JONES1, 1Wayne State University School of Medicine, Obstetrics and Gynecology, Detroit, Michigan, 2Wayne State University School of Medicine, Internal Medicine/Infectious Diseases, Detroit, Michigan OBJECTIVE: To investigate the postpartum morbidity associated with HIV infection and to determine whether advanced disease is a risk for adverse events in greater numbers than controls. STUDY DESIGN: A retrospective case control study of HIV infected pregnant women at a single urban tertiary care center during January 2000June 2005 was performed. Controls were selected utilizing a perinatal database and random number allocation. Patients with complete data were included. Morbidity was defined as endometritis, blood transfusion, wound complication, readmission or need for an unexpected procedure. The data was analyzed using chi-square, Mann Whitney U test and logistic regression where appropriate. P ! 0.05 was considered significant. RESULTS: 145 patients met the criteria for inclusion as cases and they were matched with 152 controls. Compared to controls, HIV infected women were more likely to have a cesarean delivery (40.4 vs. 15.8%, p!0.001), receive general anesthesia (4.3 vs. 0.2%, p=0.11) and to have infectious morbidity (14.6 vs. 6.9%, p=0.04). The HIV infected group had a lower BMI (27 vs. 32 kg/m2, p!0.001), shorter duration of membrane rupture (61.5 vs. 180 minutes, p!0.001) and no difference in the number of vaginal exams (4 vs. 3, p=0.64). After controlling for potential confounders, HIV infection (O.R. 4.7, 95% CI 1.4-741.5) and cesarean delivery (O.R. 6.2, 95% C.I. 2.1-505.5) were associated with an increased risk of having more than one complication. Of the HIV infected women, 19% had AIDS and 4.3% were symptomatic. The median CD4 count for the HIV infected women was 408 cells/uL. Patients with symptomatic AIDS were more likely to have infectious morbidity (66.7 vs. 12.8%, P=0.005) and a postpartum complication (66.7 vs. 20.9%, p=0.03). CONCLUSION: HIV infected patients are at an increased risk for postpartum morbidity. That risk may be greater in patients with symptomatic disease.

680 WITHDRAWN

Perioperative outcomes HIVC (N=378) HIVÿ (N=54, 659) P-value Any intraoperative complication 8.2 Intraoperative blood transfusion 2.1 Endometritis 11.6 Postpartum blood transfusion 4.0 Postpartum IV Antibiotics 28.0 Wound complication 2.1 Pneumonia 1.3 Maternal sepsis 1.1 ICU admission 1.9 Maternal death 0.8

5.4 0.9 5.8 2.0 19.7 1.3 0.3 0.2 0.8 0.1

0.06 0.01 0.0002 0.02 0.007 0.167 0.001 0.0004 0.04 !0.0001