An epidemiologic study of postcesarean infection.
Cesarean section (CS) is associated with increased postpartum infectious morbidity, predominantly endometritis. In this prospective cohort study, endometritis was found in 28% of 229 patients who underwent consecutive CS from September 1979 to May 1980 at a university hospital. When the occurrence of bacteremia and wound infection was considered, the study found 31% of the patients were infected. Among the 20 potential epidemiologic and operative risk factors for infection that were studied, the most important were primary CS, membrane rupture, labor, and meconium staining (p = 0.0001). Failure to progress, breech presentation, and fetal distress were also significantly associated with infection (p = 0.001). Another factor correlated to the rate of infection was attendance by physician in training (p = 0.002). Discriminant function analysis was used to develop an equation that correctly classified, as infected or noninfected, 76% of a sample of CS patients (p = 0.004). This sample was not part of the original sample from which the discriminant function equation was developed. Finally toward the end of the study period, we observed a decrease in the infection rate among patients of house staff physicians. This decrease has resulted in similar infection rates for patients of attending physicians and patients of house staff physicians, which have continued to the present.
D001424:Bacterial Infections / Q000209:etiology*; D001946:Breech Presentation; D002585:Cesarean Section; D004716:Endometritis / Q000209:etiology*; D005260:Female; D005316:Fetal Distress; D006801:Humans; D007396:Internship and Residency; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011446:Prospective Studies; D012306:Risk; D018805:Sepsis / Q000209:etiology; D013223:Statistics as Topic; D013530:Surgical Wound Infection / Q000209:etiology