Mothers infected with HIV.

The HIV/AIDS epidemic intersects with the problem of maternal mortality in many circumstances. The extent of the contribution of HIV/AIDS to maternal mortality is difficult to quantify, as the HIV status of pregnant women is not always known. HIV infection and AIDS-related deaths have become one of the major causes of maternal mortality in many resource-poor settings. HIV impacts on direct (obstetrical) causes of maternal mortality by an associated increase in pregnancy complications such as anaemia, post-partum haemorrhage and puerperal sepsis. HIV is also a major indirect cause of maternal mortality by an increased susceptibility to opportunistic infections such as Pneumocystis carinii pneumonia, tuberculosis and malaria. Appropriate antiretroviral therapy started in pregnancy could reverse the toll of HIV-related maternal mortality. Without such efforts and increased HIV prevention, the gains achieved by safe motherhood programmes will be lost in the future.