title: Infectious morbidity is higher after second-stage compared with first-stage cesareans.
abstract: OBJECTIVE
  The objective of the study was to compare maternal and neonatal infectious morbidity following cesareans performed in the second and first stages of labor.
  
  
  METHODS
  We conducted a retropective cohort study of all consecutive, singleton, term, cesarean deliveries in laboring women in a single institution from 2005 to 2012. Second-stage cesareans were defined as those performed at complete cervical dilation (10 cm), and first-stage cesareans were those performed before 10 cm cervical dilation. The primary outcome was endometritis. Rates of infectious morbidity were compared in the 2 groups. Multivariable logistic regression was used to calculate adjusted risk estimates.
  
  
  RESULTS
  Of 2505 cesareans meeting inclusion criteria, 400 (16.0%) were performed in the second stage, whereas 2105 (84.0%) were performed in the first stage of labor. The risk of endometritis was nearly 3-fold higher in second- compared with first-stage cesareans (4.25% vs 1.52%; crude odds ratio, 2.88; 95% confidence interval, 1.58-5.23). The risk remained significantly higher after controlling for confounders (adjusted odds ratio, 2.78; 95% confidence interval, 1.51-5.09).
  
  
  CONCLUSIONS
  Second-stage cesarean is associated with an increased risk of endometritis compared with first-stage cesarean. Further studies will determine whether different infection preventive strategies are needed at second-stage cesareans to reduce endometritis.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO. Electronic address: methodiustuuli@yahoo.com.
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Lucy
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Longman
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D004716:Endometritis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007748:Labor Stage, Second; D016015:Logistic Models; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
keywords: cesarean; first stage; infections; labor; second stage