Maternal infection rates after cesarean delivery by Pfannenstiel or Joel–Cohen incision: A multicenter surveillance study

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 147; no. 2; pp. 139 - 143
• Main Authors: Dumas, Anne Marie, Girard, Raphaële, Ayzac, Louis, Caillat-Vallet, Emmanuelle, Tissot-Guerraz, Françoise, Vincent-Bouletreau, Agnès, Berland, Michel
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-12-2009; Elsevier
• Subjects: Adolescent; Adult; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Cesarean Section - adverse effects; Cesarean Section - methods; Cross Infection - epidemiology; Cross Infection - etiology; Endometritis; Endometritis - epidemiology; Endometritis - etiology; Female; General aspects; Gynecology. Andrology. Obstetrics; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infectious diseases; Joel–Cohen technique; Logistic Models; Medical sciences; Middle Aged; Nosocomial infections; Obstetrics and Gynecology; Pfannenstiel technique; Pregnancy; Prospective Studies; Risk Factors; Joel–Cohen technique; Nosocomial infections; Endometritis; Pfannenstiel technique; Nosocomial infection; Multicenter study; Gynecology; Joel-Cohen technique; Obstetrics; Female genital diseases; Incision; Obstetrical technique; Treatment; Mother; Surveillance; Surgery; Uterine diseases; Cesarean section
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2009.08.001

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 ≥800 mL, 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.