1.Risk factors for endometritis following low transverse cesarean section
Khaliun U ; Buyan-Orshih G ; Bayarsaikhan Kh ; Lkhagva-Ochir E ; Uranchimeg R
Mongolian Medical Sciences 2023;205(4):9-15
Introduction:
Endometritis (EMM) is the most common maternal infectious complication of childbirth, occurring
more commonly after low transverse cesarean section (LTCS) than vaginal delivery [1]. In a Cochrane
review, the mean incidence of EMM following elective cesarean section was 7% and after non-elective
or emergency operations was 30% [4]. A variety of independent risk factors for post-cesarean EMM
have been identified in previous studies, including no prior cesarean section [5], low infant Apgar
scores [6], trial of labor [7], premature rupture of membranes (PROM) >24 hours, young maternal
age [8], preterm or post-term gestation [9], antepartum infections [10], pre-eclampsia, meconium [11],
amnion infusion, postpartum anemia, multiple vaginal examinations [12], and manual removal of the
placenta [13]. The time of ruptured membranes before delivery is examined via dichotomized time
thresholds, the risks of chorioamnionitis and endomyometritis are significantly increased at 12 hours
and 16 hours, respectively [16, 17]. A change in policy to administer prophylactic antibiotics before
skin incision led to a significant decline in postcesarean delivery surgical-site infections [18, 19].
Objective:
To determine independent risk factors for EMM following (LTCS).
Material and Method:
The study was case-control study, between 2022 to 2023 years at the “Urguu” specialized maternal
hospital Ulaanbaatar, Mongolia. Case group has 101 women with EMM and the control group has 100
women with non EMM after LTCS.
Results:
The age of 2 study groups was 32.4 and 32.8, body mass index was 30 kg/m2 and 30.7 kg/
m2.Young maternal age <25 has a 22% (p=0.001, OR=4.5) influence on the occurrence of EMM.
Other pregnancy related factors were not associated with the EMM after LTCS. (p>0.05). Delivery
risk factors has increases the EMM by 15% (p=0.002), labor induction by 20% (p=0.001), duration of
labor >12 hours by 40% (p=0.001), PROM increased by 15% (p=0.005), meconium by 15% (p=0.005),
chorioamnionitis by 15% (p=0.001).
Conclusion
Our study, young maternal age <25 has influence on the occurrence of EMM. Other pregnancy related
factors were not associated with the EMM after LTCS. Delivery associated risk factors are affected
by the EMM after LTCS. The labor after LTCS, labor induction, PROM >12 hours, duration of labor,
number of vaginal exams>4, meconium, chorioamnionitis increased by EMM. Young maternal age
(<25) increased the risk of EMM attached with labor association risk factors.