Maternal clinical risk factors for increased rate of post cesarean infection identified.

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Preincisional extended antibiotic prophylaxis does not prevent occurrence of maternal infections that significantly contributes to increased maternal morbidity in cesarean sections.

Maternal BMI, rupture of membranes to delivery interval, race and duration of surgery are important contributing factors towards maternal infection even after prophylactic antibiotics were given according to a study published online ahead of print in Journal of obstetrics and gynecology.

This was a secondary analysis Cesarean Section Optimal Antibiotic Prophylaxis trial (C/SOAP),that concluded that pairing Azithromycin with standard pre-incisional prophylaxis reduced the surgical site infection by nearly 50%.  Dr. Alan Tita presented the paper  at the 36^th Annual Pregnancy Meeting 2016 sponsored by the Society for Maternal-Fetal Medicine.

The secondary analysis of the data was done in an effort to further identify maternal clinical risk factors that can further reduce the risk of maternal infections.

The primary outcome studied was maternal infection and consists of  a composite of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum.

Data from all 2013 patients in the primary study was included in the secondary analysis.

After controlling for Azithromycin: maternal age, duration of ROM, duration of surgery, vertical or non-transverse skin incision, staple skin closure, BMI and labor induction significantly influenced the incidence of maternal morbidity.

After parsimonious regression model, in which those variables that were statistically non-significant were removed from the analysis, showed that black race, duration of rupture of membranes more than 6 hours and duration of surgery more than 49 minutes were significantly associated with increased maternal infection.

If duration of rupture of membrane exceeds 6 hours than the rate of maternal infection increases by 1.9 to 3.4-fold.

In addition, in unadjusted analysis patients with BMI more than 30 had 2.5 times higher risk of infection as compared to those with BMI< 25 in whom the risk of infection  was minimal.

The researchers advocate need of additional studies in patients with these risk factors to formulate guidelines for further reduction in infectious morbidity.