Chorioamnionitis and pregnancy outcome in HIV-infected African women. Pregnancy and HIV Study Group

J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Jul 1;18(3):293-8. doi: 10.1097/00042560-199807010-00015.


Objective: To assess the role of chorioamnionitis (CAM) on pregnancy outcome in HIV-1-infected (HIV-positive) pregnant women, treated for sexually transmitted diseases (STDs), during the last trimester of pregnancy in Kigali, Rwanda.

Methods: At inclusion in a prospective cohort, from July 1992 to August 1993, 561 pregnant women between 24 and 28 weeks were systematically screened for HIV infection, STDs, anemia, malaria, and hepatitis B infection; a CD4 lymphocyte count was performed. Until delivery, each woman enrolled had a monthly clinical follow-up with STD treatment when needed. The pregnancy outcome was recorded. Diagnosis of CAM was based on histologic examination of the placenta.

Results: Among the 275 placentas of HIV-negative women and 286 placentas of HIV-positive women examined, CAM was diagnosed (CAM-positive) in 27 HIV-positive women (9.8%) and in 28 HIV-negative women (9.8%). No statistical association was found between CAM and the following variables, independent of the HIV serostatus: age, parity, hepatitis B, anemia, STDs, and immune deficiency. Among HIV-negative women, CAM was significantly associated with prematurity (relative risk [RR] = 3.0; 95% confidence interval [CI] = 1.5-6.3), stillbirth (RR = 4.2; 95% CI = 1.6-11.0) and premature rupture of membranes (RR = 2.9; 95% CI = 1.4-6.1). Among HIV-positive women, early neonatal mortality was the only adverse outcome associated with CAM (RR = 2.0; 95% CI = 1.6-11.0).

Conclusions: In our study, the prevalence of CAM was low and no risk factor of CAM was identified, a probable consequence of the control factor of STDs. CAM was strongly associated with adverse pregnancy outcomes in HIV-infected women, reflecting a possible deleterious effect of HIV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chorioamnionitis / complications*
  • Chorioamnionitis / epidemiology
  • Chorioamnionitis / pathology
  • Cohort Studies
  • Female
  • Fetal Death / epidemiology
  • Fetal Membranes, Premature Rupture / epidemiology
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV-1*
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Obstetric Labor, Premature / epidemiology
  • Placenta / pathology
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Outcome*
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Rwanda / epidemiology
  • Sexually Transmitted Diseases / epidemiology