Maternal infection rates after cesarean delivery by Pfannenstiel or Joel-Cohen incision: a multicenter surveillance study.
OBJECTIVE
Our purpose was to evaluate maternal nosocomial infection rates according to the incision technique used for caesarean delivery, in a routine surveillance study.


METHODS
This was a prospective study of 5123 cesarean deliveries (43.2% Joel-Cohen, 56.8% Pfannenstiel incisions) in 35 maternity units (Mater Sud Est network). Data on routine surveillance variables, operative duration, and three additional variables (manual removal of the placenta, uterine exteriorization, and/or cleaning of the parieto-colic gutter) were collected. Multiple logistic regression analysis was used to identify independent risk factors for infection.


RESULTS
The overall nosocomial infection and endometritis rates were higher for the Joel-Cohen than Pfannenstiel incision (4.5% vs. 3.3%, 0.8% vs. 0.3%, respectively). The higher rate of nosocomial infections with the Joel-Cohen incision was due to a greater proportion of patients presenting risk factors (i.e., emergency delivery, primary cesarean, blood loss > or =800 mL, no manual removal of the placenta and no uterine exteriorization). However, the Joel-Cohen technique was an independent risk factor for endometritis.


CONCLUSIONS
The Joel-Cohen technique is faster than the Pfannenstiel technique but is associated with a higher incidence of endometritis.
Service de gynécologie-obstétrique, Centre Hospitalier Lyon Sud, Pierre Bénite, France. anne-marie.dumas@chu-lyon.fr
Anne Marie
AM
Dumas
Raphaële
R
Girard
Louis
L
Ayzac
Emmanuelle
E
Caillat-Vallet
Françoise
F
Tissot-Guerraz
Agnès
A
Vincent-Bouletreau
Michel
M
Berland
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D004716:Endometritis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors