Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors

Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.Results: Among 2419 patients, the rate of PPE was 1.6% (n=38) and was associated with lower age (27.0 versus 31.0; p<.001). 65.7% of patients having chorioamnionitits developed PPE, but only 5.4% of patients without PPE had chorioamnionitis (p<.001). On multivariate analysis, PPE was higher in emergent versus scheduled CD (OR: 5.89; p=.0081). There was no difference in PPE for cefazolin 2g versus 1g (OR: 1.91; p=.17) or 3g versus 1g (OR: 3.69; p=.29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p<.001) had higher PPE. Women with PPE were more likely to have labor arrest (OR: 4.336; p=.001), sexually transmitted infection during the pregnancy (OR: 4.197; p=.02) or blood transfusion (OR: 9.50; p<.0001).Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.