Does Uterine Wiping Influence the Rate of Post-Cesarean Endometritis?

Abstract

One of the traditional obstetrical practices not yet subject to prospective studies is to wipe the uterine cavity with a laparotomy pad after fetal and placental delivery to remove any remaining fetal membranes and placental fragments. This study compared two methods of achieving this at the time of cesarean delivery: uterine wiping (by hand, using a dry laparotomy pad) and tissue forceps. All 614 women in the uterine wipe group and 616 in the no-wipe group were uninfected at the time of nonemergency cesarean delivery. The two groups were demographically similar. All parturients received an intravenous bolus of 1 g of a first-generation cephalosporin immediately after the cord was clamped. Postpartum endometritis was diagnosed when the body temperature was 100.4°F or higher on two occasions 6 hours apart (excluding the first 24 hours) and there was uterine tenderness and/or foul-smelling lochia. Postpartum endometritis was diagnosed in 65 women having manual uterine wiping and in 66 in the no-wipe group, for respective incidence rates of 10.5% and 10.7%. None of 10 patients who received prophylaxis against subacute bacterial endocarditis developed infection. Numerous intrapartum factors including gestational age, type of anesthesia, duration of amnion rupture, method of placental removal, and total operating time did not differ significantly in the two study groups. Neonatal outcomes also were similar with respect to birth weight, umbilical artery pH, and admission to newborn intensive care. Although it may seem reasonable that removing residual membrane and placental tissue after cesarean delivery would help prevent endometritis, how this is done does not seem to be important. Manual wiping with a pad and the use of tissue forceps were comparably effective in this series.