Risk factors in the development of cesarean section infection

Fifty consecutive patients undergoing cesarean section were evaluated prospectively. A data collection form was developed and 113 variables relating to demographic features, antepartum care, intrapartum events and postpartum course were evaluated. All of the patients were seen and evaluated within 24 hours of delivery and all forms were completed when the patients were discharged from the hospital. Twenty-five of the 50 patients had postpartum febrile morbidity develop. There were 14 instances of endometritis; five, wound infections; two, urinary tract infections; two, upper respiratory tract infections; three pulmonary infections; one patient with phlebitis, and two with febrile morbidity and no apparent source. Factors significantly associated with an increased risk of developing febrile morbidity included antepartum infections, resident staff as primary surgeon, extension of the uterine incision and positive endometrial culture at the time of the operation. Patients undergoing elective repeat cesarean section had less febrile morbidity than others (p less than 0.025). Statistically significant differences between the two groups were not found for the variables obesity, anemia, rupture of membranes, number of pelvic examinations, fetal monitoring, fetal tachycardia, general anesthesia and skin preparation. Operative blood loss was greater in the patients having febrile morbidity develop, but this difference was not statistically significant.