Effect of changing gloves before placental extraction on incidence of postcesarean endometritis

Abstract

Objective We sought to determine if changing the surgeon's gloves after delivery of the infant and prior to manual placental removal decreases the incidence of postcesarean endometritis. Methods Laboring women undergoing cesarean delivery between September 1, 1994, and August 31, 1995, were prospectively randomized into either a change or no-change glove group. In the change-glove group, the surgeon's gloves were changed after delivery of the infant and before manual removal of the placenta. All patients enrolled received a single prophylactic dose of an IV antibiotic after clamping of the umbilical cord. Endometritis was diagnosed by an oral temperature of ≥ 38°C on 2 occasions at least 6 h apart and >24 h after delivery, uterine tenderness, peripheral blood leukocytosis (≥ 15,000 cells/ml), and the exclusion of other foci of infection. In order to detect a reduction in endometritis from 14% to 2%, at P < 0.05 with 80% power, we needed 95 patients in each group. Results Two hundred twenty-eight women were randomized to 2 groups: 113 were in the change group and 115 in the no-change group. No significant differences were noted between the groups with respect to demographics, duration of labor, length of ruptured membranes, number of vaginal examinations, duration of internal monitoring, length of surgery, blood loss, or infant weight. There was no decrease in the incidence of endometritis between the change group (17.7%) and the no-change group (15.7%) (relative risk 1.1, 95% confidence interval 0.75–1.47). Conclusions In this study, the incidence of postcesarean endometritis was not decreased by changing the surgeon's gloves after delivery of the infant but before placental extraction. © 1996 Wiley-Liss, Inc.