2 Black Caucasian Hispanic Insurance government Tobacco Drug use Age (years) BMI (kg/m2) Adherent antiretroviral use Predelivery CD4 (cells/mm3) †Data presented as N (%) or median (interquartile range). ∗Represents comparison across groups. 2 consisted of relatively immunocompetent HIV-infected pa- tients (CD4 ≥ 200 cells/µL) and Group 3 consisted of HIV- uninfected patients. Febrile morbidity was deﬁned as a tem- perature ≥ 38.0◦C 24 hours or greater postdelivery. Postpar- tum endometritis was deﬁned as persistently elevated tem- perature with uterine tenderness in the absence of evidence of a nonuterine etiology. Postpartum morbidity was deﬁned as anemia requiring a blood transfusion, endometritis, other infectious morbidity, wound complication, repeat admission for a pregnancy-related complication within 6 weeks postde- livery, or unexpected surgery. Infectious morbidity was de- ﬁned as the presence of endometritis, wound infection, or pneumonia. Data regarding the indication for use of intra- venous antibiotics, the use of imaging in assessment of febrile morbidity, and the time from the ﬁrst fever until initiation of intravenous (IV) antibiotics were collected as well. Postdeliv- ery length of stay (LOS) was deﬁned as the time from delivery until discharge from the hospital. STATISTICAL ANALYSIS Statistical analysis was performed utilizing the SPSS statisti- cal software (version 14.0 SPSS Inc, Chicago, IL). Wilcoxon ranks sum test and the Kruskal-Wallis test were utilized for discrete and continuous variables. The chi square test was utilized for binomial variables. A logistic regression was per- formed to evaluate possible confounders. Postpartum mor- bidity was the outcome of interest. The variables included were government insurance, age, body mass index (BMI), nulliparity, drug abuse history, smoking, cesarean section af- ter labor, intrapartum fever, general anesthesia, duration of membrane rupture, and cesarean delivery. A probability of P < .05 was signiﬁcant. RESULTS There were 148 HIV-infected patients with complete data. Of that group, 33 were diagnosed with AIDS by CDC cri- teria and 7 of those women had symptomatic AIDS. The Infectious Diseases in Obstetrics and Gynecology Table 1: Demographic data by group.† Group 1 (AIDS) Group 2 (HIV infected) Group 3 (HIV uninfected) N = 33 27(81.8) 2(6.1) 4(12.1) 24(72.7) 8(24.2) 11(33.3) 28(24–32) 27(22–32) 28(84.8) 185(108–310) N = 115 102(89.5) 8(7.0) 2(1.8) 73(65.2) 33(28.9) 28(24.6) 28(23–35) 27(24–35) 93(80.9) 534(420–720) N = 152 128(84.2) 12(7.9) 12(7.9) 128(84.2) 24(15.8) 8(5.3) 24(19–28) 32(28–37) — — P-value∗ .36 .92 .03 .002 .03 < .0001 < .0001 < .0001 uninfected control group consisted of 152 HIV-uninfected women. Table 1 consists of demographic data by group. HIV- infected women were more likely to smoke (24.2 and 28.9 versus 15.8%, P = .03), have a drug abuse history (33.3 and 24.6 versus 5.3%, P < .0001), were older (median 28 and 28 versus 24 years, P < .0001), and had a lower BMI (median 27 and 27 versus 32 kg/m2, P < .0001). Overall, 82% of the HIV-infected women were adherent with their antretroviral therapy. Clinical data are presented in Table 2. Women with AIDS were more likely to have a cesarean delivery (59.4 ver- sus 35.1 and 15.8%, P < .0001) and there was no diﬀerence in the use of prophylactic antibiotics at the time of cesarean section. Among women with a vaginal delivery, patients with AIDS had a shorter duration of rupture of membranes (me- dian 50 minutes versus 63 and 193 minutes, P < .0001) but there was no diﬀerence in the number of vaginal exams or the duration of labor. Women with AIDS were more likely to have a postpartum morbidity (32.3 versus 19.3 and 13.2%, P = .03) or an infectious morbidity (22.6 versus 11.54 and 5.3%, P = .007). The highest rate of infectious morbidity was among women with symptomatic AIDS (66%). There was no diﬀerence in febrile morbidity, hemorrhage, wound complications, and multiple complications among the three groups. Women with AIDS were more likely to have radio- logical imaging in the evaluation of febrile morbidity and a resultant delay in initiation of IV antibiotics but there was no diﬀerence in the rate of antibiotic use (Table 3). Among the imaging modalities, chest radiography was performed in 13 of the 19 patients who had imaging. One demonstrated pneumonia and the rest were negative. Abdominal and pelvic computed axial tomography was performed in 4 of the 19 of the patients, yielding the diagnosis of a pelvic abscess in one patient and a small bowel obstruction in another. Two patients had a head and neck magnetic resonance imaging (MRI); one demonstrated lesions suggestive of cryptococcal meningitis. In a logistic regression controlling for potential confounders, cesarean delivery (OR 19.5, 95% CI 5.4–69.8) and not advanced HIV disease were associated with an in- creased risk of postpartum morbidity (see Table 4).