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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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