Poster session IV Academic issues, epidemiology, global maternal-fetal public health, infectious diseases, intrapartum fetal assessment, operative obstetrics| Volume 201, ISSUE 6, SUPPLEMENT , S234, December 01, 2009

643: Is cesarean section a clean surgery?


      Elective cesarean section (C/S) is considered a clean surgery. The primary aim of this study was to evaluate the uterine microbiological contents at the time of elective and non-elective C/Ss, and to determine the risk factors for the presence of intra-uterine bacteria at the time of C/S.

      Study Design

      Aerobic uterine cultures were obtained from the uterine cavity, immediately following placental removal, but prior to cervical dilation evaluation, from all 1376 who underwent C/S in one center during one year. The medical staff was blinded to the uterine cavity culture results.


      During the 12-month study period, 1376 of 5930 deliveries in our center were C/S (23.2%). Positive endometrial cultures were detected in 115/832 (13.8%) of the elective C/Ss, and in 304/544 (55.9%) of the non-elective C/Ss (p<0.001). Of the non-elective C/Ss, positive cultures were detected in 56/196 (29%) of those without ruptured membranes and in 248/348 (71.3%) of those with ruptured membranes (p<0.001). The mean birthweight (3198gr vs. 3363gr, p=0.0295), mean 1-minute Apgar scores (8.59 vs. 8.96, p<0.001), and percent of primipara (41.8 vs. 30.5, p=0.011), were significantly lower in the women with positive cultures compared to those with negative cultures respectively. A higher percentage of women with positive uterine cultures presented with postpartum endometritis (p<0.05).


      This study demonstrated non-elective C/S, particularly C/S after membrane rupture, to be a significant risk factor for positive uterine culture. The presence of a positive uterine culture associated with lower birthweight and with postpartum endometritis.