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PubMed1997

Endometritis, salpingitis and fertilisation rates after mating mares with a history of intrauterine lumenal fluid accumulation.

The occurrence of uterine and oviductal inflammation, and fertilisation rates, were measured on Day 3 post ovulation in inseminated mares that had either exhibited intrauterine lumenal fluid during a previous dioestrus (Experiment 1) or had acute endometritis induced by intrauterine infusion of 1% glycogen (Experiment 2). Endometritis was assessed by uterine cytology and histology whereas oviductal inflammation was measured histologically. Fertilisation rates were calculated from the percentage of cleaved ova recovered by retrograde flushing of the oviducts. Mares with or without pre-existing uterine fluid during dioestrus that were inseminated showed a higher incidence of endometritis than control mares without pre-existing uterine fluid that were not inseminated (n = 7 mares/group). However, inseminated mares with uterine fluid did not show a higher incidence of endometritis than inseminated mares without uterine fluid. Mares with or without pre-existing uterine fluid showed a higher incidence of endometritis than salpingitis and these 2 groups of mares showed equivalent rates of fertilisation and oviductal oocyte recovery. Mares inseminated with semen alone or semen following 1% glycogen treatment had a higher incidence of endometritis than control noninseminated mares (n = 17 mares/group) but mares that received semen plus 1% glycogen did not show a higher incidence of endometritis than mares that received semen alone. Both these groups of mares showed a higher incidence of endometritis than salpingitis and those that received semen plus 1% glycogen showed an equal recovery rate of recently ovulated ova but a lower fertilisation rate than the mares that received semen alone.

Administration, Intravaginal↗
PubMed1996

Role of bacterial vaginosis-associated microorganisms in endometritis.

OBJECTIVE: Our goal was to define the role of bacterial vaginosis and bacterial vaginosis-associated microorganisms in endometritis. STUDY DESIGN: Endometrial biopsies were obtained for histologic and microbiologic study from 178 consecutive women with suspected pelvic inflammatory disease, and 85 of them underwent laparoscopy to diagnose salpingitis. RESULTS: Histologic endometritis was confirmed in 117 (65%) of the women. Among women who underwent laparoscopy, salpingitis was present in 68% of those with and 23% of those without endometritis. Some but not all bacterial vaginosis-associated microorganisms were linked with endometritis. By logistic regression analysis, after adjustment for bacterial vaginosis and isolation of Neisseria gonorrhoeae and Chlamydia trachomatis, endometritis was associated with endometrial N. gonorrhoeae (odds ratio 5.7, 95% confidence interval 1.8 to 17.5), C. trachomatis (odds ratio 4.8, 95% confidence interval 1.3 to 18.2), anaerobic gram-negative rods (odds ratio 2.6, 95% confidence interval 1.1 to 5.7), and nonwhite race (odds ratio 2.3, 95% confidence interval 1.1 to 4.8). CONCLUSIONS: The association of anaerobic gram-negative rods with endometritis, after adjustment for bacterial vaginosis, N. gonorrhoeae, and C. trachomatis, supports the role of these microorganisms in the etiology of histologic endometritis among women with clinically suspected pelvic inflammatory disease.

Adult↗
PubMed1998

Effects of prophylactic antibiotics on endometrial flora in women with postcesarean endometritis.

OBJECTIVE: To determine the effect of prophylactic antibiotics on endometrial and endocervical microflora upon diagnosis of postcesarean endometritis. METHODS: The medical records of patients enrolled in open-label comparative trials of therapeutic antibiotics for postpartum endometritis between 1989 and 1994 were reviewed (n = 682). Endometritis was diagnosed by a standard definition that included fever and localizing signs. Endometrial cultures were obtained by a sheathed injection/aspiration technique. Aerobes and anaerobes were isolated by standard microbiologic techniques. The primary outcome, endometrial and endocervical microflora, was compared in women who received intravenous ampicillin (2 g every 6 hours for 1-3 doses), cephalosporin (2 g every 6 hours for 1-3 doses), or no prophylaxis. Secondary outcomes included the cure of endometritis and the prevalence of wound infection in the three groups. RESULTS: Four hundred sixty-five of 682 patients (67%) had a cesarean delivery. One hundred fifty-one patients received ampicillin prophylaxis, 100 patients received cefazolin prophylaxis, 18 patients received extended-spectrum antibiotics, and 196 patients received no prophylaxis. Patients who received cefazolin prophylaxis had a significant increase in enterococcus (P < .05) and a significant decrease in Proteus species (P < .05) from endometrial samples. Patients who received ampicillin prophylaxis had a significant increase of Mycoplasma species (P < .05), Klebsiella pneumoniae (P < .0001), Escherichia coli (P = .04), and any aerobic gram-negative rod (P = .003) from endometrial samples. Ampicillin prophylaxis was associated with a decrease in Prevotella bivia (P < .05) and any anaerobe (P < .01). Endometritis cure rates were similar between prophylaxis groups and between prophylaxis and treatment groups. However, the cefazolin prophylaxis followed by cephalosporin treatment was associated with more wound infections (19%) than other prophylaxis and treatment groups, (6%, P < .01). CONCLUSION: Ampicillin and cefazolin prophylaxis alters endometrial and endocervical microflora of women who develop endometritis. Whereas these changes had no effect on endometritis cure rate (power > 80%), the association between cefazolin prophylaxis followed by an extended-spectrum cephalosporin and wound infection may warrant caution against the use of the combination.

Adult↗
PubMed1987

Rationale for treatment of endometritis in the dairy cow.

Endometritis is an inflammation of the uterine lining that is commonly initiated at parturition. The degree of its effect on fertility varies with the severity of the inflammation, the time required for resolution of endometrial lesions, and the extent of permanent changes that impair endometrial gland functions and/or alter the uterine and/or oviductal environment. The primary nonspecific organisms associated with endometrial pathology are Corynebacterium pyogenes and the gram-negative anaerobes. The majority of postpartum dairy cows have some degree of endometritis but resolve it by 40 to 50 days post partum. Cows with certain periparturient disorders involving the reproductive tract and/or a defective host immune mechanism may acquire persistent infections that impair subsequent fertility. Not all infertile cows or all cows with positive uterine cultures have endometritis. Cows recovering from C. pyogenes endometritis may require 1 month after clearance of the organism for fertility to be restored. These cows, as well as many cows with slightly delayed uterine involution at 30 days post partum, do not benefit from antimicrobial therapy. The effect of endometritis varies between herds. It is associated with prolongation of calving intervals that can vary from less than 2 weeks to 2 months or more. The cost of days open beyond 80 to 110 days post partum is currently estimated to be $2.00 to $2.25 per day. Evaluation of the bovine genital tract is best conducted by a rectal examination combined with a vaginal speculum examination. Cows selected for therapy for endometritis should meet the strict requirements of a grossly enlarged uterus and a severely abnormal uterine discharge. Induction of estrus is the treatment of choice whenever possible. When antimicrobial therapy is indicated, tetracycline is recommended for intrauterine use during the early postpartum period when mixed bacterial populations are present. Commonly used doses are 2 to 3 gm. For systemic signs of illness, systemic administration of penicillin has been recommended. Twice daily doses of 5000 to 10,000 IU of penicillin per kg may be necessary to maintain therapeutic blood concentrations. Systemic administration of an antimicrobial is necessary to achieve therapeutic concentrations in the oviducts, cervix, and vagina. With chronic endometritis due to C. pyogenes, intrauterine administration of 1 to 1.5 X 10(6) IU of procaine penicillin G has been recommended. Multiple daily treatments are desirable. Milk from treated cows should be tested for penicillin before it is added to bulk tank milk. It still is not clear whether antimicrobial therapy is cost effective.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2000

Reproductive efficiency of cows with endometritis after treatment with intrauterine infusions or prostaglandin injections, or no treatment.

Data from 3276 cows with 6598 lactations in 85 herds participating in a herd health monitoring programme were selected for an observational study. Cases of endometritis were diagnosed based on a clinical examination after 21 days postpartum. The cases were grouped by the severity of endometritis (mild, severe) and by the treatment performed (intrauterine infusion, prostaglandin injection, no treatment). The conception rates and the calving-to-conception intervals of these groups were compared statistically. Conception rate was lower in cows with severe endometritis compared to cows with mild endometritis while it did not differ between treatment groups. In cows with mild endometritis a significantly longer calving-to-conception interval was observed if intrauterine infusions were performed compared to the other two treatment options. The occurrence of other fertility problems during the same service period had a significant effect on conception rate and calving-to-conception intervals. In cows with severe endometritis intrauterine or prostaglandin treatments appeared to be beneficial, whereas intrauterine infusions in cows with slight endometritis had a negative effect on reproductive efficiency.

Animals↗
PubMed2005

Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis.

OBJECTIVE: Postcesarean endometritis and wound infection remain significant morbidities, despite use of strategies to prevent these complications. We investigated the effect of preoperative vaginal preparation with povidone-iodine as a preventive intervention against postcesarean endometritis and wound infection. METHODS: A randomized controlled study was performed in 308 women undergoing nonemergent cesarean delivery. Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotic at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity (temperature > 38.0 degrees C), endometritis (temperature > 38.4 degrees C accompanied by fundal tenderness occurring beyond the first postoperative day, in the absence of evidence of other infection), and wound infection. RESULTS: Postcesarean endometritis occurred in 7.0% of subjects who received a preoperative vaginal preparation and 14.5% of controls (P < .05). There was no measurable effect of a vaginal scrub on the development of postoperative fever or wound infection. The adjusted odds ratio for developing endometritis after a vaginal preparation was 0.44 (95% confidence interval [CI] 0.193-0.997). Multivariate analysis showed an increased risk of developing endometritis in association with severe anemia (adjusted OR 4.26, 95% CI 1.568-11.582), use of intrapartum internal monitors (adjusted OR 2.84, 95% CI 1.311-6.136), or history of antenatal genitourinary infection (adjusted OR 2.9, 95% CI 1.265-6.596). CONCLUSION: Preoperative vaginal scrub with povidone-iodine decreases the incidence of postcesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.

Adult↗
PubMed2005

Immune responses during the peripartum period in dairy cows with postpartum endometritis.

Determining the immune responses to the development of endometritis during the peripartum period may assist in the development of more efficient reproductive management regimens for dairy herds. In this study, we compared the peripartum immune responses of dairy cows that develop endometritis by 4 weeks postpartum (n = 11) to cows that did not develop this disease (n = 19). Blood samples were collected 1 week before calving, just after or during calving, and then at weeks 1, 2, 3, and 4 postpartum. Cows that developed endometriris had significantly higher total leukocyte, neutrophil, lymphocyte, and monocyte counts than the control cows (P < 0.05) at all time points. The leukocytes from cows that developed endometritis were significantly less phagocytic than those from control cows at all sampling time points (P < 0.01). The serum TNFalpha concentrations of the control cows decreased linearly from the prepartum time point (P = 0.0029), but the endometritis cows showed a different profile (P > 0.05). As a result, the serum TNFalpha concentrations were greater in the endometritis group (P < 0.01) than in the control group during the third and fourth weeks postpartum. The greater total leukocyte numbers and neutrophil, lymphocyte and monocyte counts, and the maintenance of elevated serum TNFalpha levels in the cows with endometritis may be due to infection in the postpartum period. Furthermore, the decreased phagocytic capacity of leukocytes during the peripartum period, including at the prepartum time point, makes cows more susceptible to postpartum endometritis.

Animals↗
PubMed2002

Defining and diagnosing postpartum clinical endometritis and its impact on reproductive performance in dairy cows.

The objectives of this study were to validate diagnostic criteria for clinical endometritis in postpartum dairy cows and to measure the impact of endometritis on reproductive performance. Data were collected from 1865 cows in 27 herds, including history of dystocia, twins, retained placenta, or metritis. All cows were examined once between 20 and 33 d in milk (DIM) including external inspection, vaginoscopy, and transrectal palpation of the cervix, uterus, and ovaries. All cows were followed for a minimum of 7 mo or until pregnancy or culling. Survival analysis was used to derive a case definition of endometritis based on factors associated with increased time to pregnancy. The significance of clinical findings depended on the interval postpartum when examination took place. The presence of purulent uterine discharge or cervical diameter > 7.5 cm after 20 DIM, or mucopurulent discharge after 26 DIM identified cows with clinical endometritis. Given vaginoscopy, no diagnostic criteria based on palpation of the uterus had predictive value for time to pregnancy. The prevalence of clinical endometritis was 16.9%. Vaginoscopy was required to identify 44% of these cases. Accounting for parity, herd, and ovarian status, cows with clinical endometritis between 20 and 33 DIM had a hazard ratio of 0.73 for pregnancy (took 27% longer to become pregnant), and were 1.7 times more likely to be culled for reproductive failure than cows without endometritis.

Animals↗
PubMed2002

The effect of treatment of clinical endometritis on reproductive performance in dairy cows.

The objective of this field trial was to compare the effect of intrauterine (i.u.) antibiotic or intramuscular (i.m.) prostaglandin F2 alpha (PGF2 alpha) on time to pregnancy in dairy cows diagnosed with clinical endometritis between 20 and 33 days in milk (DIM). The case definition of endometritis was the presence of purulent uterine discharge or cervical diameter > 7.5 cm, or the presence of muco-purulent discharge after 26 DIM. There were 316 cows with endometritis from 27 farms assigned randomly within herd to receive 500 mg of cephapirin benzathine intrauterine (i.u.), 500 micrograms of cloprostenol i.m., or no treatment. The rate of resolution of clinical signs 14 d after treatment was 77% and was not affected by treatment. Reproductive performance was monitored for a minimum of 7 mo after treatment. Survival analysis (multivariable proportional hazards regression) was used to measure the effect of treatment on time to pregnancy. There was no benefit of treatment of endometritis before 4 wk postpartum. Administration of PGF2 alpha between 20 and 26 DIM to cows with endometritis that did not have a palpable corpus luteum was associated with a significant reduction in pregnancy rate. Between 27 and 33 DIM, cows with endometritis treated with cephapirin i.u. had a significantly shorter time to pregnancy than untreated cows (hazard ratio = 1.63). In this time period, there was no difference in pregnancy rate between PGF2 alpha and untreated cows, but the difference in pregnancy rate between cows treated with cephapirin i.u. and with PGF2 alpha was not statistically significant. Treatment of postpartum endometritis should be reserved for cases diagnosed after 26 DIM, based on criteria that are associated with subsequent pregnancy rate.

Animals↗
PubMed2004

Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis.

CONTEXT: Chronic endometritis is reportedly observed in 3% to 10% of women undergoing endometrial biopsy for abnormal uterine bleeding. The diagnosis of chronic endometritis rests on the identification of the plasma cells. Their identification may be obscured by a mononuclear cell infiltrate, plasmacytoid stromal cells, abundant stromal mitoses, a pronounced predecidual reaction in late secretory endometrium, menstrual features, or secondary changes due to exogenous progesterone treatment prior to the biopsy. Syndecan-1 is a proteoglycan that is found on the cell surface of plasma cells and keratinocytes. Immunohistochemistry stains for this antibody may facilitate diagnosis of chronic endometritis. OBJECTIVE: To determine whether or not routine syndecan-1 immunohistochemistry will aid in the diagnosis of chronic endometritis. DESIGN: Immunohistochemistry stains for syndecan-1 were performed on 3 levels of 47 endometrial biopsies from patients with abnormal uterine bleeding. None of the patients had endometrial hyperplasia or an underlying malignancy. Clinical correlation and follow-up was attempted in 20 cases that showed evidence of plasma cells by syndecan-1 by immunohistochemistry. RESULTS: Plasma cells were identified in 20 cases, 7 of which were initially diagnosed as chronic endometritis. The remaining 13 positive cases were diagnosed as tubal metaplasia (1), secretory endometrium (4), proliferative endometrium (4), menstrual endometrium (1), endometrial polyp (1), secretory endometrium with endometrial polyp (1), and endometrial polyp with exogenous hormone effect (1) based on the original hematoxylin-eosin section. CONCLUSIONS: Syndecan-1 may be a useful adjunct in the diagnosis of chronic endometritis. Approximately half of the cases of chronic endometritis responded to an antibiotic regime; thus, this diagnosis is important and may potentially obviate the need for surgical intervention.

Adult↗
PubMed1990

A clinical and microbiologic analysis of risk factors for puerperal endometritis.

Predictors of postpartum endometritis were identified in 607 asymptomatic, laboring women. One hundred (16.5%) developed postpartum endometritis. Multivariate analysis using stepwise logistic regression identified cesarean delivery (relative risk 12.8; P less than .0001) as the dominant overall predictor. In patients with cesarean delivery (N = 124), prophylactic antibiotics (relative risk 0.54; P less than .0002) and high-virulence bacteria or Mycoplasma hominis (relative risk 1.4; P less than .01) predicted the incidence of endometritis, and in patients with vaginal delivery (N = 483), "bacterial vaginosis organisms" (relative risk 14.2; P less than .001) and aerobic gram-negative rods (relative risk 4.2; P less than .01) predicted endometritis. Despite significant associations found on univariate analysis, clinical variables such as duration of labor, rupture of membranes, and internal monitoring were not predictive of endometritis in the multivariate analysis. Our findings show that cesarean delivery and certain organisms, such as bacterial vaginosis or high-virulence organisms, predict endometritis, and that clinical variables may be facilitators rather than predictors of endometritis.

Adult↗
PubMed1980

[Relationship of endometritis to intra-uterine tocography (author's transl)].

815 internal monitored labors were compared with 610 non monitored labors in two groups monitored labor (group 1 without cesarean section, forceps, manual delivery, and group 2 with cesarean section, forceps or manual delivery); the incidence of post partum endometritis has been compared with the same group 1 and 2 of non monitored labor. In group 1 the rate of endometritis was higherr in monitored labors (15 endometritis among 468 cases; 3,2%) than in the non monitored labors (6 endometritis among 441 cases, 1,8%): the difference was in border line significance (p between 0,05 and 0,10). The rate of endometritis was also in group 2 higher (20 endometritis among 347 cases (5,2%) than in non monitored labor (3 endometritis among 169 cases (1,7%) (p < 0,05).

Delivery, Obstetric↗
PubMedDate not supplied

Hospital readmission for postpartum endometritis.

This study identified risk factors associated with readmission for postpartum endometritis. The study group consisted of 109 mothers (Group I) who were discharged after delivery and readmitted with endometritis. Control groups consisted of women who had endometritis immediately after delivery but who did not require readmission (Group II, n = 109), and women who had no intrapartum or puerperal infection and also were not readmitted (Group III, n = 109). Subjects in Groups II and III were matched to an index study subject for date of delivery and maternal age, race, and parity; and women in Groups I and III were also matched for route of delivery. Groups were compared in terms of demographic characteristics, intrapartum course, and clinical presentation. The data were analyzed with the t-test, chi2, and multiple logistic regression analyses, and a P value < .05 was considered significant. Women in Groups I and III delivered vaginally more often than mothers in Group II. In addition, mothers in Groups I and III had similar postpartum courses, no evidence of infection on discharge after delivery, and a similar period from delivery until postpartum discharge. Although women in Group I were more likely to have spontaneous rupture of membranes, a shorter latent period, and have fewer bilateral tubal ligations than mothers in Group II, multivariate analysis identified route of delivery as the only significant maternal variable associated with postpartum endometritis requiring readmission. Women who were readmitted for endometritis usually delivered vaginally, and the occurrence of late-onset postpartum endometritis was unrelated to the length of stay following delivery.

Adult↗
PubMed2004

Antibiotic regimens for endometritis after delivery.

BACKGROUND: Postpartum endometritis, which is more common after cesarean section, occurs when vaginal organisms invade the endometrial cavity during labor and birth. Antibiotic treatment is warranted. OBJECTIVES: The effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's trials register (30 January 2004). SELECTION CRITERIA: Randomized trials of different antibiotic regimens for postpartum endometritis, after cesarean section or vaginal birth, where outcomes of treatment failure or complications were reported were selected. DATA COLLECTION AND ANALYSIS: We abstracted data independently and made comparisons between different types of antibiotic regimen based on type of antibiotic and duration and route of administration. Summary relative risks were calculated. MAIN RESULTS: Thirty-eight trials with 3983 participants were included. Fifteen studies comparing clindamycin and an aminoglycoside with another regimen showed more treatment failures with the other regimen (relative risk (RR) 1.44; 95% confidence interval (CI) 1.15 to 1.80). Failures of those regimens with poor activity against penicillin resistant anaerobic bacteria were more likely (RR 1.94; 95% CI 1.38 to 2.72). In three studies that compared continued oral antibiotic therapy after intravenous therapy with no oral therapy, no differences were found in recurrent endometritis or other outcomes. In four studies comparing once daily with thrice daily dosing of gentamicin there were fewer failures with once daily dosing. There was no evidence of difference in incidence of allergic reactions. Cephalosporins were associated with less diarrhea. REVIEWERS' CONCLUSIONS: The combination of gentamicin and clindamycin is appropriate for the treatment of endometritis. Regimens with activity against penicillin- resistant anaerobic bacteria are better than those without. There is no evidence that any one regimen is associated with fewer side effects. Once uncomplicated endometritis has clinically improved with intravenous therapy, oral therapy is not needed.

Anti-Bacterial Agents↗
PubMed1982

Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section.

At the time cesarean section, amniotic fluid was collected transabdominally from 60 patients, and quantitative cultures were performed on the amniotic fluid. A culture was defined as positive if greater than or equal to 10(2) colony-forming units per milliliter of a high-virulence organism were isolated. Any other result was defined as negative. In 24 patients with no labor or rupture of the membranes, no positive cultures were found, but there was a 25% incidence of endometritis. Among 36 patients with labor or rupture of the membranes, or both, 13 (36%) had a positive culture. Twelve of the 13 (92%) developed endometritis, whereas nine of the 23 (39%) patients with a negative culture had endometritis (p less than 0.002). The usual clinical risk factors for endometritis were not different between the positive and negative culture groups. However, the patients with positive cultures had a significantly shorter time interval from cesarean section to endometritis than did the patients with negative cultures (p less than 0.02). There was an excellent correlation between a positive amniotic fluid culture and endometritis after cesarean section.

Adult↗
PubMed1989

Risk factors for fever, endometritis and wound infection after abdominal delivery.

Risk factors for postoperative fever, endometritis and wound infection were analyzed in 761 consecutive cesarean sections. Postoperative fever was observed in 12%, endometritis in 4.7% and wound infection in 3% of cases. The relative risk for postoperative fever was increased in cases with postoperative hematoma (relative risk = 16.0), in cases with blood loss over 500 g (relative risk = 1.8) and if the duration of labor exceeded 6 h (relative risk = 1.9). The only significant risk factors for endometritis were amnionitis (relative risk = 8.7), postoperative hematoma (relative risk = 5.0) and age under 24 years (relative risk = 3.0). Wound infections were less frequent in cases with previous cesarean sections (relative risk = 0.15) and after elective cesarean sections (relative risk = 0.22), but duration of operation over 1 h (relative risk = 2.8), induction of labor (relative risk = 3.2) and puerperal endometritis (relative risk = 7.9) increased the risk of wound infection. By elimination of amnionitis and postoperative hematomas the rate of endometritis would have diminished only from 4.7% to 3.8%, a percentage equally unacceptable; diagnostics and prevention should be directed to young patients undergoing caesarean section. Besides technical procedures prevention of endometritis is important for the prevention of wound infection. In hospitals with low postcesarean infectious morbidity antibiotic prophylaxis seems to be unwarranted.

Cesarean Section↗
PubMed1996

The effect of manual removal of the placenta on post-cesarean endometritis.

OBJECTIVE: To determine if intraoperative glove change and placental delivery method affect the post-cesarean endometritis rate. METHODS: After informed consent, women who required cesarean were randomly assigned to one of four study groups: 1) no glove change plus manual placental extraction, 2) no glove change plus spontaneous placental delivery, 3) glove change plus manual extraction, and 4) glove change plus spontaneous delivery. Bilateral glove change by both primary and assistant surgeons occurred immediately after delivery of the newborn and before delivery of the placenta. External uterine massage and traction on the umbilical cord were performed to assist spontaneous delivery of the placenta. A first-generation cephalosporin was routinely administered after umbilical cord clamping for prophylaxis of post-cesarean endometritis. RESULTS: Of 760 women entered into the study, we included 643 who did not have intrapartum chorioamnionitis or cesarean hysterectomy. The four groups were comparable with respect to selected maternal and intrapartum characteristics, including maternal and gestational age, parity, presence of labor, and the presence and duration of membrane rupture. The postoperative endometritis rate was significantly higher in women whose placentas were extracted manually (31 versus 22%, P = .01). Operator glove change did not alter the incidence of endometritis (relative risk 1.0, 95% confidence interval 0.79-1.3). CONCLUSION: Manual extraction of the placenta is associated with a significantly greater risk of post-cesarean endometritis than that observed with assisted spontaneous placental delivery. Intraoperative glove change does not decrease post-cesarean endometritis.

Adult↗
PubMed1995

Comparison of case-finding methodologies for endometritis after cesarean section.

BACKGROUND: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity. However, traditional case-finding methods for endometritis may not identify most cases. We compared various case-finding methods with a reference method to determine a simple and accurate method for collecting data on endometritis after cesarean section. METHODS: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991. These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and admission and discharge diagnoses. RESULTS: Each case-finding method was compared separately with the reference method ("gold standard"), which was designed to capture all cases among the patients in the study population (N = 145). This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures). The computerized report method linking patients who underwent cesarean section with antibiotic use had a positive predictive value of 0.53. Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively. CONCLUSIONS: In our institution, case finding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with i.v. antibiotic use data and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis. It also represents the most efficient use of the infection control department's resources.

Anti-Bacterial Agents↗