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Risk Factors for Endometritis after Low Transverse Cesarean Delivery

Published online by Cambridge University Press:  02 January 2015

Margaret A. Olsen ,
Anne M. Butler ,
Denise M. Willers ,
Gilad A. Gross ,
Preetishma Devkota  and
Victoria J. Fraser
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Anne M. Butler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Denise M. Willers
Affiliation:
Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
Gilad A. Gross
Affiliation:
Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
Preetishma Devkota
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, Box 8051, 660 South Euclid, St Louis, MO 63110 (molsen@im.wustl.edu)
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Extract

Objective.

To determine independent risk factors for endometritis after low transverse cesarean delivery.

Study Design.

We performed a retrospective case-control study during the period from July 1999 through June 2001 in a large tertiary care academic hospital. Endometritis was defined as fever beginning more than 24 hours or continuing for at least 24 hours after delivery plus fundal tenderness in the absence of other causes for fever. Independent risk factors for endometritis were determined by means of multivariable logistic regression. A fractional polynomial method was used to examine risk of endometritis associated with the continuous variable, duration of rupture of membranes.

Results.

Endometritis was identified in 124 (7.7%) of 1,605 women within 30 days after low transverse cesarean delivery. Independent risk factors for endometritis included younger age (odds ratio [OR], 0.93 [95% confidence interval {CI}, 0.90-0.97]) and anemia or perioperative blood transfusion (OR, 2.18 [CI, 1.30-3.68] ). Risk of endometritis was marginally associated with a proxy for low socioeconomic status, lack of private health insurance (OR, 1.72 [CI, 0.99-3.00]); with amniotomy (OR, 1.69 [CI, 0.97-2.95]); and with longer duration of rupture of membranes.

Conclusion.

Risk of endometritis was independently associated with younger age and anemia and was marginally associated with lack of private health insurance and amniotomy. The odds of endometritis increased approximately 1.7-fold within 1 hour after rupture of membranes, but increased duration of rupture was only marginally associated with increased risk. Knowledge of these risk factors can guide selective use of prophylactic antibiotics during labor and heighten awareness of the risk in subgroups at highest risk of infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 69 - 77
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Martin, JA, Hamilton, BE, Sutton, PD, et al. Births: final data for 2005. Natl Vital Stat Rep 2007;56:1–103.Google ScholarPubMed
2.Burrows, LJ, Meyn, LA, Weber, AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 2004;103:907–912.CrossRefGoogle ScholarPubMed
3.Smaili, F, Hofmeyr, GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002; CD000933. Available at: http://mrw .interscience.wiley.com/cochrane/clsysrev/articles/CD000933/frame.html. Accessed August 1, 2008.Google Scholar
4.Chaim, W, Bashiri, A, Bar-David, J, Shoham-Vardi, I, Mazor, M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000;8:77–82.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
5.Tita, AT, Hauth, JC, Grimes, A, Owen, J, Stamm, AM, Andrews, WW. Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis. Obstet Gynecol 2008;111:51–56.CrossRefGoogle ScholarPubMed
6.Ely, JW, Rijhsinghani, A, Bowdler, NC, Dawson, JD. The association between manual removal of the placenta and postpartum endometritis following vaginal delivery. Obstet Gynecol 1995;86:1002–1006.Google Scholar
7.Caughey, AB, Stotland, NE, Washington, AE, Escobar, GJ. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol 2007;196:155–156.Google Scholar
8.Starr, RV, Zurawski, J, Ismail, M. Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis. Obstet Gynecol 2005;105:1024–1029.CrossRefGoogle ScholarPubMed
9.Tran, SH, Caughey, AB, Musei, TJ. Meconium-stained amniotic fluid in associated with puerperal infections. Am J Obstet Gynecol 2003;189:746750.Google Scholar
10.Jazayeri, A, Jazayeri, MK, Sahinler, M, Sincich, T. Is meconium passage a risk factor for maternal infection in term pregnancies? Obstet Gynecol 2002;99:548–552.Google Scholar
11.Anorlu, RI, Maholwana, B, Hofmeyr, GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 2008; CD004737. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004737/frame.html. Accessed July 1, 2008.Google Scholar
12.Andrews, WW, Hauth, JC, Cliver, SP, Savage, K, Goldenberg, RL. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol 2003;101:1183–1189.Google ScholarPubMed
13.Sullivan, SA, Smith, T, Chang, E, Hulsey, T, Vandorsten, JP, Soper, D. Administration of cefazolin prior to skin incision in superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial (published correction appears in Am J Obstet Gynecol 2007;197:333). Am J Obstet Gynecol 2007;196:455.e1–455.e5. Available at: http://www.ajog.org/article/PIIS000293780700347X. Accessed July 1, 2008.CrossRefGoogle Scholar
14.Reid, VC, Hartmann, KE, MCMahon, M, Fry, EP. Vaginal preparation with povidone iodine and postcesarean infectious morbidity: a randomized controlled trial. Obstet Gynecol 2001;97:147–152.Google Scholar
15.Locksmith, GJ, Clark, P, Duff, P. Maternal and neonatal infection rates with three different protocols for prevention of group B streptococcal disease. Am J Obstet Gynecol 1999;180:416–422.Google Scholar
16.Tran, SH, Cheng, YW, Kaimal, AJ, Caughey, AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol 2008;198:700–705.CrossRefGoogle ScholarPubMed
17.Seaward, PG, Hannah, ME, Myhr, TL, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol 1997;177:1024–1029.CrossRefGoogle ScholarPubMed
18.Yokoe, DS, Christiansen, CL, Johnson, R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001;7:837–841.CrossRefGoogle ScholarPubMed
19.Yokoe, DS, Noskin, GA, Cunningham, SM, et al. Enhanced identification of postoperative infections. Emerg Infect Dis 2004;10:1924–1930.Google Scholar
20.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
21.Olsen, MA, Butler, AM, Willers, DM, Devkota, P, Gross, GA, Fraser, VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008;29:477–484.CrossRefGoogle ScholarPubMed
22.Sauerbrei, W, Royston, P. Building multivariable prognostic and diagnostic models: transformation of the predictors using fractional polynomials. J R Stat Soc Ser A 1999;162:71–94.Google Scholar
23.Meier-Hirmer, C, Ortseifen, C, Sauerbrei, W. Multivariable fractional polynomials in SAS-an algorithm for determining the transformation of continuous covariates and selection of covariates. Freiburg, Germany: Institute of Medical Biometry; 2003. Updated April 13, 2005. Available at: http://www.imbi.uni-freiburg.de/download/mfp/. Accessed December 16, 2007.Google Scholar
24.Royston, P, Sauerbrei, W. Multivariable Model-Building: A Pragmatic Approach to Regression Analysis Based of Fractional Polynomials for Modelling Continuous Variables. West Sussex, England: John Wiley & Sons; 2008.Google Scholar
25.Magee, KP, Blanco, JD, Graham, JM, Rayburn, C, Prien, S. Endometritis after cesarean: the effect of age. Am J Perinatol 1994;11:24–26.CrossRefGoogle ScholarPubMed
26.Apisarnthanarak, A, Holzmann-Pazgal, G, Hamvas, A, Olsen, MA, Fraser, VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003;112:1283–1289.CrossRefGoogle Scholar
27.Marik, PE, Corwin, HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008;36:2667–2674.CrossRefGoogle ScholarPubMed
28.Olsen, MA, Lock-Buckley, P, Hopkins, D, Polish, LB, Sundt, TM, Fraser, VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002;124:136–145.CrossRefGoogle ScholarPubMed
29.Olsen, MA, Lefta, M, Dietz, JR, et al. Risk factors for surgical site infection after major breast surgery. J Am Coll Surg 2008;207:326–335.Google Scholar
30.Olsen, MA, Nepple, JJ, Riew, KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90:62–69.Google Scholar
31.Cervia, JS, Wenz, B, Ortolano, GA. Leukocyte reduction's role in the attenuation of infection risks among transfusion recipients. Clin Infect Dis 2007;45:1008–1013.CrossRefGoogle ScholarPubMed
32.Llewelyn, CA, Taylor, RS, Todd, AA, Stevens, W, Murphy, MF, Williamson, LM. The effect of universal leukoreduction of postoperative infections and length of hospital stay in elective orthopedic and cardiac surgery. Transfusion 2004;44:489–500.CrossRefGoogle ScholarPubMed
33.Frietsch, T, Karger, R, Scholer, M, et al. Leukodepletion of autologous whole blood has n. impact on perioperative infection rate and length of hospital stay. Transfusion 2008;48:2133–2142.Google Scholar
34.D'Angelo, D, Williams, L, Morrow, B, et al. Preconception and interconception health status of women who recently gave birth to a live-born infant-Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR Surveill Summ 2007;56:1–35.Google ScholarPubMed
35.Catov, JM, Bodnar, LM, Ness, RB, Markovic, N, Roberts, JM. Association of periconceptional multivitamin use and risk of preterm or small-for-gestational-age births. Am J Epidemiol 2007;166:296–303.CrossRefGoogle ScholarPubMed
36.Laraia, BA, Bodnar, LM, Siega-Riz, AM. Pregravid body mass index in negatively associated with diet quality during pregnancy. Public Health Nutr 2007;10:920–926.CrossRefGoogle ScholarPubMed
37.Goldenberg, RL. The plausibility of micronutrient deficiency in relationship to perinatal infection. J Nutr 2003;133(5Suppl 2):1645S–1648S.Google Scholar
38.Morse, CG, High, KP. Nutrition, immunity, and infection. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Mandeli, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2005:139–148.Google Scholar
39.Dumas, AM, Girard, R, Ayzac, L, et al. Effect of intrapartum antibiotic prophylaxis against group B streptococcal infection of comparisons of rates of endometritis and urinary tract infection in multicenter surveillance. Infect Control Hosp Epidemiol 2008;29:327–332.CrossRefGoogle ScholarPubMed