[Maternal morbidity after abdominal cesarean section in relation to bacterial amniotic fluid colonization and premature rupture of fetal membranes]

Abstract

At the time of Caesarean section, amniotic fluid was collected transabdominally from 1025 patients. In 990 patients cultures were performed on the amniotic fluid. The incidence of Caesarean section of all patients was 16.1%, the perinatal mortality in all patients 0.61%, in cases of Caesarean section 1.93%. The influence of bacterial colonisation in the amniotic cavity was analyzed with respect to premature ruptured membranes and frequency of vaginal examinations on the maternal post-operative morbidity (wound-seroma and abscess 2.4%, febrile morbidity 17%, urinary tract infection 19%). Bacterial contamination was present in 33.3% of the amniotic fluid or uterine cavity, after ruptured membranes in 44.3%, without ruptured membranes in 23.35%. There is a significant influence of the positive cultured amniotic fluid on the wound healing and on the febrile morbidity, while the urinary tract infection has been not influenced. The bacterial contamination of the amniotic fluid is correlated to the frequency of vaginal examination and the presence of ruptured membranes. The following microbiologic isolates were found in the amniotic fluids: Staphylococcus epidermidis 36.38%, Streptococcus B 12.23%, Streptococcus D 10.3%, Escherichia coli 8.42%, Staphylococcus aureus 7.88%, Peptococci 3.26%, Streptococcus salivarius 2.99%, Bacteroides 2.4%. According to these data, patients with ruptured membranes of an interval of more than 12 hrs and with more than 7 vaginal examinations could be selected for antibiotic prophylaxis to achieve a reduction in febrile morbidity and in wound infection.