Incidence Of Endomyometritis Research Articles

Incidence of Postpartum Endomyometritis Following Single-Dose Antibiotic Prophylaxis With Either Ampicillin/Sulbactam, Cefazolin, or Cefotetan in High-Risk Cesarean Section Patients

Objective To assess the efficacy of single-dose antibiotic prophylaxis against postpartum endomyometritis in high-risk cesarean section patients. Design Patients were administered one of three single-dose antibiotic regimens following umbilical cord clamping after cesarean section delivery. Setting Prospective randomized trial at a university-based hospital. Patients The study evaluated 293 consenting women undergoing cesarean section who had either experienced labor for a duration of 6 hr or rupture of amniotic membranes. Main outcome measures Development of postpartum endomyometritis. Results The incidence of postpartum endomyometritis was 7/95 (7.4%) following the ampicillin/sulbactam regimen, 14/98 (14.3%) after the cefazolin regimen, and 11/99 (11.1%) after the cefotetan regimen. There was no significant difference in postpartum infection among the three study arms. In addition, the incidence of endomyometritis in the three single-dose study arms was not higher than previously noted in studies where three doses of antibiotic were administered. Conclusion Single-dose antibiotic prophylaxis should replace the standard triple-dose therapy for uninfected women undergoing cesarean section who are at risk for postoperative endomyometritis. Ampicillin/sulbactam, cefazolin, and cefotetan are all reasonable antibiotic choices for single-dose therapy. Infect. Dis. Obstet. Gynecol. 6:220–223, 1998. © 1998 Wiley-Liss, Inc.

Antibiotic irrigation of the uterus at Caesarian section with cefoxitin sodium in an attempt to reduce the incidence of endomyometritis and wound infection

Antibiotic irrigation of the uterus at Caesarian section with cefoxitin sodium in an attempt to reduce the incidence of endomyometritis and wound infection

Bacterial colonization of amniotic fluid in patients with intact membranes during labor.

Amniotic fluid from gravidas with intact membranes was obtained for bacteriologic culture at the time of cesarean section. The incidence of positive cultures from patients not in labor was 8%. When the length of labor was eight hours or less (mean 6.1 hours) and the membranes were intact, the incidence of positive cultures was 37%; in patients whose length of labor was 12 hours or less (mean 9.7 hours) with intact membranes, 55% of cultures were positive. The incidence of endomyometritis in patients with bacterial growth from the amniotic fluid cultures in each group was 33%, 33%, and 45%, respectively.

Septic Dermatitis of the Neonatal Scalp and Maternal Endomyometritis with Intrapartum Internal Fetal Monitoring

During a 3-month period, 1,062 mother-infant pairs were studied for infections following internal fetal monitoring during labor. Six infants (0.56%) developed septic scalp dermatitis at the site of the spiral electrode application. Factors associated with septic scalp dermatitis included the number of vaginal examinations, the use of an intrauterine pressure catheter or of more than one spiral electrode, and fetal scalp blood sampling. Maternal diabetes and endomyometritis were also associated with an increased risk of scalp infection. The duration of spiral electrode use and duration of ruptured membranes were not significant risk factors. Endomyometritis was documented in 41 mothers, an overall incidence of 3.9%. In women whose babies were delivered by cesarean section, the incidence of endomyometritis was 28/117 (23.9%). Using multivariate analysis by logistic regression, endomyometritis was associated with the number of vaginal examinations during labor but not with the duration of internal monitoring, duration of labor, or duration of ruptured membranes.

Febrile Morbidity following Cefamandole Nafate Intrauterine Irrigation during Cesarean Section

The effectiveness of intrauterine irrigation during cesarean section with a solution of cefamandole nafate in reducing febrile morbidity was studied in a prospective double-blind fashion. Ninety patients who were undergoing cesarean section at Tripler Army Medical Center were randomized into three groups: (1) intrauterine irrigation with cefamandole nafate solution, (2) intrauterine irrigation with normal saline solution, and (3) no irrigation. Febrile morbidity was evaluated by means of a fever index. There was a statistically significant reduction in the fever index in the group that received intrauterine irrigation with cefamandole nafate. The incidences of clinically diagnosed endomyometritis in the three groups were 0%, 26.7%, and 23.3%, respectively. Prophylactic intrauterine irrigation with cefamandole nafate during cesarean section markedly reduces febrile morbidity, primarily by reducing the incidence of endomyometritis.

Febrile morbidity following cefamandole nafate intrauterine irrigation during cesarean section

The effectiveness of intrauterine irrigation during cesarean section with a solution of cefamandole nafate in reducing febrile morbidity was studied in a prospective double-blind fashion. Ninety patients who were undergoing cesarean section at Tripler Army Medical Center were randomized into three groups: (1) intrauterine irrigation with cefamandole nafate solution, (2) intrauterine irrigation with normal saline solution, and (3) no irrigation. Febrile morbidity was evaluated by means of a fever index. There was a statistically significant reduction in the fever index in the group that received intrauterine irrigation with cefamandole nafate. The incidences of clinically diagnosed endomyometritis in the three groups were 0%, 26.7%, and 23.3%, respectively. Prophylactic intrauterine irrigation with cefamandole nafate during cesarean section markedly reduces febrile morbidity, primarily by reducing the incidence of endomyometritis.

Prophylactic Use of Cefazolin in Monitored Obstetric Patients Undergoing Cesarean Section

Prophylactic cefazolin was evaluated in high-risk obstetric patients who had invasive fetal monitoring and subsequent cesarean section. A three-dose regimen of either cefazolin or placebo was administered randomly in a double-blind manner to 93 patients, 48 receiving cefazolin and 45 placebo, with the first dose given when the cord was clamped. In the placebo group, 51% of the patients were treated for endomyometritis compared to 29% in the cefazolin group. The incidence of urinary tract and wound infections was similar in the 2 groups. One patient in the active drug group was diagnosed as having septic pelvic thrombophlebitis and received multiple antibiotics and heparin before she recovered. One patient in the placebo group required triple antibiotic therapy. Operation to control infection was not required in any patients and there were no maternal deaths. The cefazolin patients had fewer degree-hours of morbidity as calculated by the quantitative fever index (P less than 0.002). The perioperative use of cefazolin was efficacious in reducing the incidence of endomyometritis, but did not prevent serious postoperative pelvic infection.