Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched‐pair setting with women from the general population in Denmark, 2002−2014

Objectives We aimed to assess mode of delivery and predictors of emergency caesarean section (Em CS ) in women living with HIV ( WLWH ) in a matched‐pair setting with women from the general population ( WGP ) in Denmark. Further, we analysed birth plan in WLWH . Methods All WLWH giving birth to live‐born children from 2002 to 2014 were included in the study. Data were retrieved from medical records and national registries. WLWH were matched 1:5 by age, birth year, parity and ethnicity to WGP . Multivariate logistic regression was used to estimate predictors. Results We included 389 WLWH and 1945 WGP in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA <40 HIV ‐1 RNA copies/ mL . Mean age was 32.7 years [95% confidence interval ( CI ) 32.1–33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective caesarean section ( ECS ), 40.6% versus 9.7%, respectively; Em CS , 26% versus 17%, respectively; P < 0.0001]. Age > 40 years [adjusted odds ratio ( aOR ) 2.3; 95% CI 1.5–3.5], asphyxia ( aOR 3.2; 95% CI 2.4–4.1), delivery during the evening and at night [ aOR 2.3 (95% CI 1.7–3.0) and aOR 2.0 (95% CI 1.5–2.7), respectively], preterm delivery ( aOR 3.8; 95% CI 2.6–5.6) and premature rupture of membranes ( aOR 3.0; 95% CI 2.1–4.4) predicted Em CS . WLWH had a higher risk of Em CS compared with WGP [2002–2006, aOR 2.0 (95% CI 1.2–3.3); 2007–2008, aOR 2.9 (95% CI 1.4–5.9); 2009–2014, aOR 2.6 (95% CI 1.7–3.9)]. After 2007, more than half of WLWH planned to deliver vaginally. Prior caesarean section was associated with ECS ( aOR 11.0; 95% CI 4.5–26.8). No mother‐to‐child transmission occurred. Conclusions Increasing numbers of WLWH deliver vaginally. Despite virological suppression, more WLWH plan and deliver by ECS than WGP . WLWH had a twofold higher risk of Em CS compared with WGP .