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Infectious morbidity is higher after second-stage compared with first-stage cesareans
Methodius G Tuuli1, Lucy Liu1, Ryan E Longman1
1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
American Journal of Obstetrics and Gynecology
|March 25, 2014
Summary
Cesarean delivery during the second stage of labor significantly increases the risk of endometritis, a common infection. This finding highlights potential needs for enhanced infection prevention strategies in second-stage cesarean births.
Area of Science:
- Obstetrics and Gynecology
- Surgical Infectious Diseases
- Maternal-Fetal Medicine
Background:
- Cesarean delivery is a common surgical procedure.
- Infection remains a significant complication following cesarean births.
- The timing of cesarean delivery within the labor continuum may influence infectious morbidity.
Purpose of the Study:
- To compare maternal infectious morbidity, specifically endometritis, between cesarean deliveries performed in the second stage of labor versus the first stage.
- To evaluate the impact of labor stage at the time of cesarean delivery on the risk of postpartum infection.
Main Methods:
- Retrospective cohort study of term, singleton cesarean deliveries from 2005-2012.
- Defined second-stage cesareans as those at complete cervical dilation (10 cm) and first-stage before 10 cm.
- Used multivariable logistic regression to analyze the primary outcome of endometritis and adjusted risk estimates.
Main Results:
- A total of 2505 cesareans were analyzed; 16.0% were second-stage and 84.0% were first-stage.
- Second-stage cesareans showed a nearly 3-fold higher risk of endometritis (4.25% vs 1.52%).
- This increased risk remained significant after adjusting for confounders (adjusted OR, 2.78).
Conclusions:
- Cesarean delivery performed during the second stage of labor is independently associated with a significantly higher risk of developing endometritis.
- The findings suggest a potential need for revised or enhanced infection prevention protocols for second-stage cesarean deliveries.
- Further research is warranted to confirm these findings and explore specific preventive measures.
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