A Comparative Study of Septic Complications in HIVInfected and HIV-Uninfected Women Undergoing Caesarean Section at the University Teaching Hospital, Lusaka, Zambia

Background: There is evidence in support of the benefit of caesarean section for the prevention of mother to child transmission of HIV (PMTCT). Information on the extent of complications and maternal mortality associated with caesarean section in HIV infected women in low resourcesettings is lacking though some studies have reported increased risk of maternal complications associated with caesarean section in HIV infected women (particularly sepsis).Objective: This study was designed to determine the incidence of post caesarean maternal complications, particularly those due to sepsis, at the University Teaching Hospital (UTH) and compare complications in HIV infected and HIV uninfected women.Design and setting: A prospective cohort study documenting complications in women undergoing caesarean section at UTH in Lusaka. All consecutivepatients undergoing caesarean section at UTH in September 2010 and with a known HIV status were recruited. Consenting participants were followed up for six (6) weeks after the caesarean section. All complications were documented.Results: Fifty eight (19.4%) HIV positive and 241 (80.6%) HIV negative women were followed up. Overall, 27 (9%) women had sepsis (6 were HIV positive and 21 were HIV negative; 10.3 vs. 8.7% respectively). Theunadjusted odds ratio for sepsis in HIV positive vs. HIV negative women was 1.21 (95% CI 0.40-3.15). Adjusting for potential confounders (age, emergency or elective caesarean section, type of skin preparation, use of preeoperative antibiotics, blood loss, duration of operation) did not significantly alter the odds ratio (OR 1.39, 95% CI 0.5-3.6).Conclusion: Sepsis complicated 9% of caesarean sections at UTH though this complication was not independently associated with HIV status. Further studies are needed to address which factors contribute to postcaesareancomplications