Abstract
Objective: To determine whether hypothermia during Cesarean delivery is a risk factor for postoperative infection.
Methods: An historical cohort investigation was conducted on all women delivered by Cesarean at our center during 2001. Initial recovery-room temperature, taken via the oral or axillary route, was used as a surrogate for intraoperative temperature. Adding 0.5°C to axillary temperatures generated oral temperature equivalents. Women with chorioamnionitis were excluded, as were those with an initial recovery-room temperature that exceeded 37.9°C or was recorded more than 20 minutes after the end of surgery. Prophylactic antibiotics (cefazolin, 1 g) were given during Cesarean delivery.
Results: A total of 42 women (7.6%) were diagnosed with postoperative infections. Infections included endometritis (n= 25), wound abscess (n = 7), wound cellulitis (n = 7) and urinary tract infection (UTI) (n = 4). No cases of septic pelvic thrombophlebitis or pelvic abscess occurred. One woman had both endometritis and a UTI. Mean temperatures were higher, rather than lower, for women who subsequently had postoperative infections compared with those who did not (36.4 ± 0.8°Cvs. 35.9 ± 0.7°C; p < 0.001). Mean temperatures for the various postoperative infections were as follows: endometritis, 36.5 ± 0.8°C (p < 0.001 vs. uninfected group); wound abscess 36.0 ± 0.8°C (p = 0.63); wound cellulitis, 36.3 ± 0.6°C (p = 0.14); UTI, 36.7 ± 0.9°C (p = 0.04).
Conclusions: Women who develop post-Cesarean infections have higher initial recovery-room temperatures than those who do not develop such infections. This suggests the presence of subclinical infection at the time of Cesarean. Evaluating whether intraoperative warming has any role during Cesarean delivery requires a randomized clinical trial.
Full Text
The Full Text of this article is available as a PDF (360.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blanco J. D., Gibbs R. S., Castaneda Y. S., St Clair P. J. Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section. Am J Obstet Gynecol. 1982 Aug 15;143(8):897–901. doi: 10.1016/0002-9378(82)90470-7. [DOI] [PubMed] [Google Scholar]
- Chang N., Mathes S. J. Comparison of the effect of bacterial inoculation in musculocutaneous and random-pattern flaps. Plast Reconstr Surg. 1982 Jul;70(1):1–10. doi: 10.1097/00006534-198207000-00001. [DOI] [PubMed] [Google Scholar]
- Gibbs R. S., Blanco J. D., St Clair P. J. A case-control study of wound abscess after cesarean delivery. Obstet Gynecol. 1983 Oct;62(4):498–501. [PubMed] [Google Scholar]
- Gilstrap L. C., 3rd, Cunningham F. G. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979 May;53(5):545–549. [PubMed] [Google Scholar]
- Hohn D. C., MacKay R. D., Halliday B., Hunt T. K. Effect of O2 tension on microbicidal function of leukocytes in wounds and in vitro. Surg Forum. 1976;27(62):18–20. [PubMed] [Google Scholar]
- Jönsson K., Hunt T. K., Mathes S. J. Oxygen as an isolated variable influences resistance to infection. Ann Surg. 1988 Dec;208(6):783–787. doi: 10.1097/00000658-198812000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kurz A., Sessler D. I., Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996 May 9;334(19):1209–1215. doi: 10.1056/NEJM199605093341901. [DOI] [PubMed] [Google Scholar]
- Martin Joyce A., Park Melissa M., Sutton Paul D. Births: preliminary data for 2001. Natl Vital Stat Rep. 2002 Jun 6;50(10):1–20. [PubMed] [Google Scholar]
- Munn M. B., Rouse D. J., Owen J. Intraoperative hypothermia and post-cesarean wound infection. Obstet Gynecol. 1998 Apr;91(4):582–584. doi: 10.1016/s0029-7844(98)00009-x. [DOI] [PubMed] [Google Scholar]
- Owen J., Andrews W. W. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994 Dec;37(4):842–855. doi: 10.1097/00003081-199412000-00009. [DOI] [PubMed] [Google Scholar]
- Ozaki M., Sessler D. I., Suzuki H., Ozaki K., Tsunoda C., Atarashi K. Nitrous oxide decreases the threshold for vasoconstriction less than sevoflurane or isoflurane. Anesth Analg. 1995 Jun;80(6):1212–1216. doi: 10.1097/00000539-199506000-00025. [DOI] [PubMed] [Google Scholar]
- Sheffield C. W., Sessler D. I., Hunt T. K. Mild hypothermia during isoflurane anesthesia decreases resistance to E. coli dermal infection in guinea pigs. Acta Anaesthesiol Scand. 1994 Apr;38(3):201–205. doi: 10.1111/j.1399-6576.1994.tb03873.x. [DOI] [PubMed] [Google Scholar]
- Sheffield C. W., Sessler D. I., Hunt T. K., Scheuenstuhl H. Mild hypothermia during halothane-induced anesthesia decreases resistance to Staphylococcus aureus dermal infection in guinea pigs. Wound Repair Regen. 1994 Jan;2(1):48–56. doi: 10.1046/j.1524-475X.1994.20108.x. [DOI] [PubMed] [Google Scholar]
- Taffel S. M., Placek P. J., Moien M., Kosary C. L. 1989 U.S. cesarean section rate steadies--VBAC rate rises to nearly one in five. Birth. 1991 Jun;18(2):73–77. doi: 10.1111/j.1523-536x.1991.tb00063.x. [DOI] [PubMed] [Google Scholar]
- Yancey M. K., Clark P., Duff P. The frequency of glove contamination during cesarean delivery. Obstet Gynecol. 1994 Apr;83(4):538–542. doi: 10.1097/00006250-199404000-00009. [DOI] [PubMed] [Google Scholar]
- van Oss C. J., Absolom D. R., Moore L. L., Park B. H., Humbert J. R. Effect of temperature on the chemotaxis, phagocytic engulfment, digestion and O2 consumption of human polymorphonuclear leukocytes. J Reticuloendothel Soc. 1980 Jun;27(6):561–565. [PubMed] [Google Scholar]