Maternal and fetal outcomes of HIV-infected and non-infected pregnant women admitted to two intensive care units in Pietermaritzburg, South Africa
Background. Outcomes of HIV-positive pregnant patients admitted to intensive care units (ICUs) are controversial.
Objective. To determine maternal and fetal outcomes of HIV-positive patients admitted to ICUs.
Methods. Pregnant patients admitted to ICUs were enrolled in the study. On admission, they were classified as having low (<50%) or high (≥50%) risk of death by GRAMPT stratification score. The primary maternal outcome was death or hypoxic-ischaemic brain injury (HIBI), while fetal outcomes recorded were Apgar score, birth weight, and delivery of the fetus to facilitate maternal care.
Results. There were 84 admissions to the ICUs: 66 (78.6%) were post-partum and 18 (21.4%) antepartum. The HIV sero-status was as follows: 11 (13.1%) HIV status unknown; 42 (50%) HIV-negative and 31 (36.9%) HIV-positive. The most common pre-ICU admission diagnoses were pneumonia (19.4%) in HIV-positive patients and eclampsia (31%) in HIV-negative patients. Maternal outcomes showed a worsening trend among the HIV-positive women when compared with those who were HIV-negative (high GRAMPT, 1.91 relative risk of death/HIBI in HIV-positive; 95% CI 0.57 - 6.44). Forty-two patients gave birth within 24 hours prior to ICU admission; 3 gave birth while in ICU and none gave birth within 24 hours following ICU discharge. Outcomes of the 45 infants born to HIV-positive women were worse than for those born to HIV-negative patients (except for Apgar scores 1 - 6). Performance of the GRAMPT model for prediction of maternal mortality/HIBI was best in hypertensive patients (ROC: AUC 0.72; 95% CI 0.48 - 0.96).
Conclusion. With the exception of Apgar scores 1 - 6, all outcomes showed worsening trends among infants born to HIV-positive mothers. Large multicentre studies are needed to confirm our findings.
N C Ngene, Department of Obstetrics and Gynaecology, Grey’s Hospital, Pietermaritzburg; University of KwaZulu-Natal, South Africa
J Moodley, Department of Obstetrics and Gynaecology and Women’s Health and HIV Research Group, University of KwaZulu-Natal, South Africa
P Songca, Department of Obstetrics and Gynaecology, Edendale Hospital, Pietermaritzburg, South Africa
R von Rahden, Anaesthetist, Grey’s Hospital, Pietermaritzburg, South Africa
F Paruk, Cardiothoracic Intensive Care Unit, Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa
C O Onyia, General practitioner, Pietermaritzburg, South Africa
S van der Linde, School of Public Health and Nursing, University of KwaZulu-Natal, South Africa
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Date published: 2013-06-05
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