Maternal infection rates after cesarean delivery by Pfannenstiel or Joel–Cohen incision: A multicenter surveillance study
Received 1 February 2008; received in revised form 18 June 2008; accepted 4 August 2009. published online 01 September 2009.
Abstract
Objective
Our purpose was to evaluate maternal nosocomial infection rates according to the incision technique used for caesarean delivery, in a routine surveillance study.
Study design
This was a prospective study of 5123 cesarean deliveries (43.2% Joel–Cohen, 56.8% Pfannenstiel incisions) in 35 maternity units (Mater Sud Est network). Data on routine surveillance variables, operative duration, and three additional variables (manual removal of the placenta, uterine exteriorization, and/or cleaning of the parieto-colic gutter) were collected. Multiple logistic regression analysis was used to identify independent risk factors for infection.
Results
The overall nosocomial infection and endometritis rates were higher for the Joel–Cohen than Pfannenstiel incision (4.5% vs. 3.3%, 0.8% vs. 0.3%, respectively). The higher rate of nosocomial infections with the Joel–Cohen incision was due to a greater proportion of patients presenting risk factors (i.e., emergency delivery, primary cesarean, blood loss ≥800mL, no manual removal of the placenta and no uterine exteriorization). However, the Joel–Cohen technique was an independent risk factor for endometritis.
Conclusion
The Joel–Cohen technique is faster than the Pfannenstiel technique but is associated with a higher incidence of endometritis.
aService de gynécologie-obstétrique, Centre Hospitalier Lyon Sud (CHLS), Pierre Bénite, France
bUnité d’hygiène et épidémiologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
cC Clin Sud Est, Centre Hospitalier Lyon Sud, Pierre Bénite, France
dUnité d’Hygiène et d’Epidémiologie, Hôpital Edouard Herriot, Lyon, France
Corresponding author at: Service d’Obstétrique et de Gynécologie, Centre Hospitalier Lyon Sud (Pavillon 3B), 165 chemin du grand revoyet, 69495 Pierre Bénite Cedex, France. Tel.: +33 478 86 56 06; fax: +33 478 86 56 04.
ABSTRACT