Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women.
OBJECTIVE
To compare the risk of postpartum infections within 30 days after vaginal birth, emergency, or elective cesarean section (CS).


METHODS
Register-based cohort study in Denmark.


METHODS
A total of 32,468 women giving birth in hospitals in the County of Aarhus, Denmark, during the period 2001-2005.


METHODS
Data from various hospital registries were combined and infections were identified by positive cultures, prescriptions for antibiotics and, re-operative procedures.Risk of postpartum infection was estimated and adjustment for potentially confounders was performed.


RESULTS
Within 30 days postpartum, 7.6% of women who had underwent CS and 1.6% of women having a vaginal birth acquired an infection, yielding an adjusted odds ratio (OR) of 4.71, 95% confidence interval (CI): 4.08-5.43. The prevalence of postpartum urinary tract infection (UTI) was 2.8%, after CS and 1.5% after vaginal birth corresponding to an adjusted OR = 1.68, 95% CI: 1.38-2.03. The risk of UTI did not differ between emergency and elective CS. The prevalence of WI was 5.0% after CS and 0.08% after vaginal birth. Moreover, we found a nearly 50% higher risk of postpartum WI after emergency CS compared to elective CS (OR = 1.49, 95% CI: 1.13-1.97). More than 75% (697/907) of postpartum infections appeared after hospital discharge.


CONCLUSIONS
The risk of postpartum infection seems to be nearly five-fold increased after CS compared with vaginal birth. This may be of concern since the prevalence of CS is increasing.
Leth
Rita Andersen
RA
Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. ritaleth@rm.dk
Møller
Jens Kjølseth
JK
Thomsen
Reimar Wernich
RW
Uldbjerg
Niels
N
Nørgaard
Mette
M
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*; D055815:Young Adult