Infectious morbidity in laboring vs. non-laboring patients undergoing Cesarean section
Methods: We reviewed the medical records of a cohort of all patients undergoing Cesarean section at our 400 bed hospital from January 1, 2012- November 30, 2013. The physician and nurse epidemiologist and the director of labor and delivery abstracted data. Fever was defined as 30.0 degrees C and infections were definied using both NHSN defined criteria and clinical assessment.
Results: Among the 869 deliveries by Cesarean section during this time period, 868 medical records were available for review. The average age of women undergoing C section was 28.8. 24.8% of women were African American, 29.3% were Caucasian, and 27.7% were Hispanic. Ethnicity was not documented in 10.2% of charts. 23.8% of women were positive for group B streptococcus, 59.3% were negative and 16.5% had unknown group B streptococcus status. The overall infectious morbidity was 22% (190/868). 13% (115/868) of women had a fever pre or post-delivery and 58.8% of women labored prior to cesarean delivery. In women who were laboring prior to cesarean, the infectious morbidity rate was 27.6% (141/511) with an NHSN defined infection rate of 4.5%. The overall infectious morbidity in patients who did not labor was significantly lower at 10.6% (38/357) with an NHSN defined infection rate of 1.1%.
Conclusion: Our results demonstrate that there is a higher than expected burden of infectious complications related to Cesarean section delivery, and that laboring patients have a higher rate of febrile illness compared to non-laboring patients. As more patients are allowed labor after previous Cesarean section, preventable risk factors for surgical site infections among these patients need to be identified to develop evidence based interventions.
J. M. Zenilman, None
T. M. Perl, None
C. Argani, None