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  • Title: Post-cesarean section puerperal morbidity. The incidence and risk factors at Srinagarind Hospital.
    Author: Pothinam S, Chanpoo T, Lumbiganon P.
    Journal: J Med Assoc Thai; 1992 Mar; 75(3):173-7. PubMed ID: 1506796.
    Abstract:
    We found that the incidence of post-cesarean puerperal morbidity at Srinagarind Hospital, Khon Kaen University was 5.5 per cent, which is very low compared to other reports. Statistically significant risk factors for post-cesarean puerperal morbidity included having less than 4 antenatal care visits, duration of labour longer than 12 hours and absence of prophylactic antibiotics. All patients who delivered by Cesarean section at Srinagarind Hospital, Khon Kaen University, from June 1, 1988 to May 31, 1989 were studied to determine the incidence and risk factors of puerperal morbidity. Variables included age, parity, gestational age at delivery, blood concentration before delivery, number of antenatal care visits, duration of labor, duration of rupture of membranes before delivery, number of vaginal examinations, history of previous Cesarean section, type of Cesarean section, type of anesthesia, estimated blood loss, operative time, fetal birth weight, and the use of antibiotics. Puerperal morbidity was defined as a temperature of 38 degrees Celsius or higher, occurring on any 2 of the first 10 days post partum exclusive of the first 24 hours. Univariate and multiple logistic regression analyses were used for the assessment of the risk factors. There were 548 Cesarean sections, but 42 patients were excluded, leaving 506 patients. There were 132 elective and 374 emergency Cesarean sections. The incidence of post-Cesarean puerperal morbidity was 5.5%, which is very low compared to other reports, and it was 6.5% in patients who did not receive antibiotics. The causes of puerperal morbidity included endomyometritis (35.7%), wound infection (25.0%), urinary tract infection (10.7%) and unknown cause (28.6%). Only duration of labor for more than 12 hours was found to be a statistically significant risk factor. Other factors including parity, number of antenatal care visits, history of previous Cesarean section, estimated blood loss during operation, and the use of antibiotics were found to be almost statistically significant. Further analysis by multiple logistic regression with all statistically significant and almost statistically significant variables found that statistically significant risk factors for post-Cesarean puerperal morbidity included having less than 4 antenatal care visits, duration of labor longer than 12 hours, and absence of prophylactic antibiotics.
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