Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors. (3rd May 2018)

• Record Type: Journal Article
• Authors: Moulton, Laura J.; Lachiewicz, Mark; Liu, Xiaobo; Goje, Oluwatosin
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 9(2018)
• Page Start: 1214
• Page End: 1219
• Publication Date: 2018-05-03
• Subjects: Postpartum endomyometritis -- cesarean delivery -- antibiotic prophylaxis; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1312330
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors. Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically. Results: Among 2419 patients, the rate of PPE was 1.6% ( n = 38) and was associated with lower age (27.0 versus 31.0; p < .001). 65.7% of patients having chorioamnionitits developed PPE, but only 5.4% of patients without PPE had chorioamnionitis ( p < .001). On multivariate analysis, PPE was higher in emergent versus scheduled CD (OR: 5.89; p = .0081). There was no difference in PPE for cefazolin 2 g versus 1 g (OR: 1.91; p = .17) or 3 g versus 1 g (OR: 3.69; p = .29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p < .001) had higher PPE. Women with PPE were more likely to have labor arrest (OR: 4.336; p = .001), sexually transmitted infection during the pregnancy (OR: 4.197; p = .02) or blood transfusion (OR: 9.50; p < .0001). Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.