title: Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors.
abstract: OBJECTIVE
  To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.
  
  
  METHODS
  A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.
  
  
  RESULTS
  Among 2419 patients, the rate of PPE was 1.6% (n = 38) and was associated with lower age (27.0 versus 31.0; p < .001). 65.7% of patients having chorioamnionitits developed PPE, but only 5.4% of patients without PPE had chorioamnionitis (p < .001). On multivariate analysis, PPE was higher in emergent versus scheduled CD (OR: 5.89; p = .0081). There was no difference in PPE for cefazolin 2 g versus 1 g (OR: 1.91; p = .17) or 3 g versus 1 g (OR: 3.69; p = .29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p < .001) had higher PPE. Women with PPE were more likely to have labor arrest (OR: 4.336; p = .001), sexually transmitted infection during the pregnancy (OR: 4.197; p = .02) or blood transfusion (OR: 9.50; p < .0001).
  
  
  CONCLUSIONS
  While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.
authors.affiliation: a Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic , Cleveland , OH , USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Moulton
authors.affiliation: b Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lachiewicz
authors.affiliation: c Quantitative Health Sciences Department , Cleveland Clinic , Cleveland , OH , USA.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Liu
authors.affiliation: a Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic , Cleveland , OH , USA.
authors.forename: Oluwatosin
authors.initials: O
authors.lastname: Goje
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D002821:Chorioamnionitis / Q000175:diagnosis / Q000453:epidemiology; D002981:Clindamycin / Q000627:therapeutic use; D004716:Endometritis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005839:Gentamicins; D002981:Clindamycin; D002437:Cefazolin
keywords: Postpartum endomyometritis; antibiotic prophylaxis; cesarean delivery