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Postpartum Complications and Anesthetic Considerations in Parturients Infected with Human Immunodeficiency Virus: Case Series and Literature Review
Abstract Number: SAT-49
Abstract Type: Original Research
It has been reported that 75.9% of women infected with the human immunodeficiency virus (HIV) are at childbearing age. This study aims to offer renewed information about anesthesia and postpartum complications and changes in immune function and viral load in HIV-infected parturients.
A retrospective review of medical records from 2002 to 2016 and a review of the literature were conducted. Data endpoints included: newly onset complications in 6 months after delivery and differences of indices assessing immune function (CD4 and CD8 T-cell lymphocyte counts, CD4/CD8 ratio) and HIV-1 viral load between baseline and postpartum values. Paired T-test and Wilcoxon Rank Sum test were used for statistical analysis according to different requirements of data.
We collected and analyzed data of totally 50 patients. There were 36 cases of epidural anesthesia (72%), 9 of spinal anesthesia (18%), 3 of combined spinal epidural anesthesia (6%), and 2 of general anesthesia (4%, for the safety for fetus). 19 minor complications were noted. There were no differences between the indices values (of CD4 count, CD8 count, CD4/CD8 ratio, and HIV-1 viral load) before and after delivery. With the available medication records of 49 patients, all of them received regular ART medication continuously.
Hughes et al found in 18 HIV-infected parturients administered with epidural or spinal anesthesia for delivery that there were no changes in the immunologic parameters, and HIV disease remained stable in the peripartum period. It is known that general anesthesia may exacerbate the stress response to surgery and lead to impaired immune function. We confirmed the stability of HIV disease in a longer period (6 months) after delivery without significant complications in parturients received either neuraxial or general anesthesia. Tom et al administered autologous EBP to 6 patients who experienced PDPH after diagnostic lumbar puncture and did not identify morbidity attributable to EBP with a two-year follow-up. However, the case with suspected PDPH in our study was not received EBP. In the guidelines from ACOG, current trend for HIV-infected women is to take ART before, during and after their pregnancies. This study also supports the benefits of ART from the aspect of anesthesia for HIV-infected parturients.
1. Hughes SC, et al. Anesthesiology 1995; 82: 32
2. Tom DJ, et al. Anesthesiology 1992; 76:943