Changing patterns of maternal mortality (HIV/AIDS related) in poor countries.

Maternal mortality is greatest in poor countries and it is in exactly these countries that the human immunodeficiency virus (HIV) poses an added challenge in attaining the Millennium Development Goals. The prevalence of HIV infection in many poor countries continues to rise. South Africa is an example of how some of the challenges can be addressed. Recommendations by the South African National Committee on the Confidential Enquiry into Maternal Deaths stressed the importance of addressing the antenatal, intrapartum and postpartum care of women, laying emphasis on the need for societal support, including nutritional and emotional support, reproductive health services including contraception, provider-initiated counselling and testing (PICT) and prevention. Antenatal care needs to be targeted for support and early intervention when abnormalities are detected, including the initiation of highly active antiretroviral therapy when necessary. Intrapartum care needs to be conducted in a hygienic environment with access to operative delivery. More attention needs to be paid to postpartum care because most women tend to succumb to puerperal sepsis. Ethical principles must be upheld when managing women with HIV infection.