Postpregnancy Genital Tract and Wound Infections

Nell Tharpe, CNM, CRNFA, MS

Disclosures

J Midwifery Womens Health. 2008;53(3):236-246. 

In This Article

Epidemiology of Postpartum Infection

In an epidemiologic review of health maintenance organization, inpatient, and ambulatory care electronic medical records, pharmacy dispensing data, and administrative claims, Yokoe et al.[12] found that surgical site infections account for 3.4% of all post-cesarean infections (n = 525), while 0.3% of the women who gave birth vaginally (n = 2301) developed episiotomy infections. In women who gave birth vaginally, mastitis (3%) was the most common postpartum infection followed by urinary tract infections (2%). In this review, 15% of births were associated with at least one automated screening code for postpartum infection, with 94% of infections detected after hospital discharge. In this study population, 74% of women with postdischarge infections were evaluated and treated in the outpatient setting.[12] Hebert et al.[3] analyzed the incidence of prolonged hospitalization, re-admissions, and maternal mortality following childbirth in a cohort of 33,251 women who gave birth through the Tennessee Medicaid program in 1991. Infection occurred in 1.8% of the women who gave birth vaginally (n = 452 of 25,810) and 7.9% of the women who had a cesarean birth (n = 588 of 7441).

Additionally, the incidence of wound infection and puerperal fever occurs more frequently in women who undergo labor before cesarean birth compared to women who undergo cesarean in the absence of labor. In a 14-year, population-based study (n = 18,435), Allen et al.[13] reported the incidence of wound infection in women undergoing cesarean birth without labor (n = 721) to be 1.5%, compared to 0.4% in women who had a spontaneous vaginal birth (n = 12,607), 2.0% in women who had an assisted vaginal delivery (n = 3,613), and 2.2% in women who had a cesarean during labor (n = 1480). Similarly, puerperal fever occurred in 1.1% of women undergoing cesarean birth without labor, in 0.2% of women who had a spontaneous vaginal birth, in 0.4% of women with assisted vaginal delivery, and in 3.3% of women undergoing cesarean during labor.[13]

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