HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis
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{"title"=>"HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis", "type"=>"generic", "authors"=>[{"first_name"=>"Clara", "last_name"=>"Calvert", "scopus_author_id"=>"55307572800"}, {"first_name"=>"Carine", "last_name"=>"Ronsmans", "scopus_author_id"=>"7004258124"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"sgr"=>"84885081916", "doi"=>"10.1371/journal.pone.0074848", "pui"=>"369964473", "issn"=>"19326203", "pmid"=>"24124458", "isbn"=>"19326203", "scopus"=>"2-s2.0-84885081916"}, "id"=>"df9c868f-1873-36e9-a38a-c21bfa43aaff", "abstract"=>"BACKGROUND: Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.\\n\\nMETHODS AND FINDINGS: Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent.\\n\\nCONCLUSIONS: The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.", "link"=>"http://www.mendeley.com/research/hiv-risk-direct-obstetric-complications-systematic-review-metaanalysis-2", "reader_count"=>47, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>2, "Researcher"=>10, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>8, "Student > Master"=>13, "Other"=>1, "Student > Bachelor"=>5, "Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>2, "Researcher"=>10, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>8, "Student > Master"=>13, "Other"=>1, "Student > Bachelor"=>5, "Lecturer"=>1, "Professor"=>2}, "reader_count_by_subject_area"=>{"Nursing and Health Professions"=>6, "Medicine and Dentistry"=>28, "Agricultural and Biological Sciences"=>1, "Business, Management and Accounting"=>3, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>2, "Social Sciences"=>4, "Economics, Econometrics and Finance"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>28}, "Social Sciences"=>{"Social Sciences"=>4}, "Psychology"=>{"Psychology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}}, "reader_count_by_country"=>{"Norway"=>1, "Brazil"=>1, "South Africa"=>1, "Nigeria"=>1, "Ethiopia"=>1}, "group_count"=>5}

Scopus | Further Information

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Figshare

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  • {"files"=>["https://ndownloader.figshare.com/files/1225304"], "description"=>"<p>Forest plot showing the strength of association between HIV and obstetric haemorrhage in studies with vaginal deliveries only or included both vaginal deliveries and c-section deliveries.</p>", "links"=>[], "tags"=>["hiv", "obstetric", "haemorrhage", "studies", "vaginal", "deliveries", "included", "c-section"], "article_id"=>815154, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g002", "stats"=>{"downloads"=>5, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_obstetric_haemorrhage_in_studies_with_vaginal_deliveries_only_or_included_both_vaginal_deliveries_and_c_section_deliveries_/815154", "title"=>"Forest plot showing the strength of association between HIV and obstetric haemorrhage in studies with vaginal deliveries only or included both vaginal deliveries and c-section deliveries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225307"], "description"=>"<p><sup>*</sup>Adjusted odds ratio.</p>", "links"=>[], "tags"=>["hiv", "hypertensive", "diseases"], "article_id"=>815157, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g003", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_hypertensive_diseases_of_pregnancy_/815157", "title"=>"Forest plot showing the strength of association between HIV and hypertensive diseases of pregnancy.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225308"], "description"=>"<p><sup>*</sup>Adjusted odds ratio.</p>", "links"=>[], "tags"=>["hiv"], "article_id"=>815158, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g004", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_dystocia_/815158", "title"=>"Forest plot showing the strength of association between HIV and dystocia.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225309"], "description"=>"<p>Forest plot showing the strength of association between HIV and intrauterine infection.</p>", "links"=>[], "tags"=>["hiv", "intrauterine"], "article_id"=>815159, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g005", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_intrauterine_infection_/815159", "title"=>"Forest plot showing the strength of association between HIV and intrauterine infection.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225310"], "description"=>"<p><sup>*</sup>Adjusted odds ratio.</p>", "links"=>[], "tags"=>["hiv", "intrauterine", "studies", "looked", "caesarean"], "article_id"=>815160, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g006", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_intrauterine_infection_in_studies_which_only_looked_at_caesarean_deliveries_/815160", "title"=>"Forest plot showing the strength of association between HIV and intrauterine infection in studies which only looked at caesarean deliveries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225311"], "description"=>"<p>Forest plot showing the strength of association between HIV and caesarean section in studies included in this systematic review.</p>", "links"=>[], "tags"=>["hiv", "caesarean", "studies", "included", "systematic"], "article_id"=>815161, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.g007", "stats"=>{"downloads"=>2, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_strength_of_association_between_HIV_and_caesarean_section_in_studies_included_in_this_systematic_review_/815161", "title"=>"Forest plot showing the strength of association between HIV and caesarean section in studies included in this systematic review.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225312"], "description"=>"1<p>Information was not supplied in the published paper so whether antiretroviral treatment should have been available was based on the study dates and study location; for two studies it was not clear from the study dates and location whether ART would be available so the information was inferred from the literature.</p><p>a) Bangkok, Thailand between 2001: No ART treatment based on the UNAIDS data accessed on 29th October 2012 at <a href=\"http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/\" target=\"_blank\">http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/</a>.</p><p>b) Bloemfontein, South Africa in 2001: No ART treatment based on the UNAIDS data accessed on 29th October 2012 at <a href=\"http://www.unaids.org/en/regionscountries/countries/southafrica/\" target=\"_blank\">http://www.unaids.org/en/regionscountries/countries/southafrica/</a>.</p>2<p>Adjusted for smoking and cocaine use.</p>3<p>Adjusted for age, type of house, the distance from home to Mulago hospital, permission to attend health unit, person paying for hospital upkeep, previous length of labour and previous delivery by c-section.</p>", "links"=>[], "tags"=>["studies", "hiv", "obstetric", "complications", "included", "births", "vaginal"], "article_id"=>815162, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.t001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_studies_of_HIV_and_obstetric_complications_which_included_births_by_vaginal_delivery_/815162", "title"=>"Summary of studies of HIV and obstetric complications which included births by vaginal delivery.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225313"], "description"=>"1<p>Adjusted odds ratios stratified by two time periods were available but were not extracted.</p>", "links"=>[], "tags"=>["studies", "vaginal"], "article_id"=>815163, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.t003", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_bias_within_studies_which_include_vaginal_deliveries_/815163", "title"=>"Risk of bias within studies which include vaginal deliveries.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225314"], "description"=>"1<p>Information was not supplied in the published paper so whether antiretroviral treatment should have been available was based on the study dates and study location; for one study it was not clear from the study dates and location whether ART would be available so the information was inferred from the literature.</p><p>a) Durban, South Africa in 2004: No ART treatment based on the UNAIDS data accessed on 20th December 2012 at <a href=\"http://www.unaids.org/en/regionscountries/countries/southafrica/\" target=\"_blank\">http://www.unaids.org/en/regionscountries/countries/southafrica/</a>.</p>2<p>Adjusted for number of previous caesarean section.</p>", "links"=>[], "tags"=>["studies", "hiv", "obstetric", "complications", "looked", "births", "caesarean"], "article_id"=>815164, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.t002", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_studies_of_HIV_and_obstetric_complications_which_only_looked_at_births_by_caesarean_section_/815164", "title"=>"Summary of studies of HIV and obstetric complications which only looked at births by caesarean section.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225315"], "description"=>"<p>Risk of bias within caesarean section studies.</p>", "links"=>[], "tags"=>["caesarean"], "article_id"=>815165, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0074848.t004", "stats"=>{"downloads"=>6, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_bias_within_caesarean_section_studies_/815165", "title"=>"Risk of bias within caesarean section studies.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-10-04 02:14:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1225316", "https://ndownloader.figshare.com/files/1225317"], "description"=>"<div><p>Background</p><p>Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.</p><p>Methods and findings</p><p>Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00–5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42–13.97). For other obstetric complications the evidence was weak and inconsistent.</p><p>Conclusions</p><p>The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.</p></div>", "links"=>[], "tags"=>["obstetric", "systematic"], "article_id"=>815166, "categories"=>["Biological Sciences"], "users"=>["Clara Calvert", "Carine Ronsmans"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0074848.s001", "https://dx.doi.org/10.1371/journal.pone.0074848.s002"], "stats"=>{"downloads"=>3, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_HIV_and_the_Risk_of_Direct_Obstetric_Complications_A_Systematic_Review_and_Meta_Analysis_/815166", "title"=>"HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-10-04 02:14:06"}

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  • {"unique-ip"=>"37", "full-text"=>"52", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2018", "month"=>"6"}
  • {"unique-ip"=>"21", "full-text"=>"21", "pdf"=>"6", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"33", "full-text"=>"38", "pdf"=>"8", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"37", "full-text"=>"39", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"37", "full-text"=>"43", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"34", "full-text"=>"34", "pdf"=>"6", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"25", "full-text"=>"27", "pdf"=>"6", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"45", "full-text"=>"50", "pdf"=>"14", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"25", "full-text"=>"25", "pdf"=>"11", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}

Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[269, 466, 588, 697, 800, 896, 988, 1076, 1165, 1254, 1340, 1417]}, {"subject_area"=>"/Biology and life sciences/Microbiology", "average_usage"=>[293, 503, 638, 755, 861, 960, 1056, 1146, 1239, 1323, 1403, 1491, 1568]}, {"subject_area"=>"/Biology and life sciences/Organisms", "average_usage"=>[281, 484, 611, 728, 835, 934, 1030, 1123, 1214, 1299, 1383, 1464]}, {"subject_area"=>"/Medicine and health sciences/Surgical and invasive medical procedures", "average_usage"=>[223, 396, 511, 599, 690, 775, 859, 936, 1012, 1090, 1168, 1237, 1299]}, {"subject_area"=>"/Medicine and health sciences/Vascular medicine", "average_usage"=>[222, 394, 496, 593, 683, 762, 835, 910, 980, 1047, 1116, 1184, 1244]}]}
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