Chlamydia trachomatis and febrile complications of postpartum tubal ligation

Abstract

Objective: Our goal was to determine whether chlamydia-infected women have a higher rate of febrile complications after postpartum tubal ligation.

Study design: Cross-sectional analysis of 1447 women tested for chlamydial infection within 2 weeks of delivery and who underwent postpartum tubal ligation was performed. Subjects were identified with the Regenstrief Institute for Health Care database. Infected subjects were compared with uninfected subjects for incidence of fever not explained by nongynecologic sources.

Results: Women infected with Chlamydia trachomatis at delivery were more likely to experience febrile postoperative complications after tubal ligation (p < 0.0001, relative risk 9.5, 95% confidence interval 4.5 to 20.1).

Conclusion: Women undergoing postpartum tuba ligation may benefit from prompt diagnosis and preoperative treatment of chlamydial infection.

PIP: A cross-sectional analysis of 1447 US women who underwent postpartum tubal ligation and were tested for Chlamydia trachomatis within 2 weeks of delivery revealed a significant (p 0.0001) increased risk (odds ratio, 9.5; 95% confidence interval, 4.5-20.1) of febrile postoperative complications in untreated chlamydia-positive women. A total of 36 women (2.5%) tested positive for chlamydia at delivery. Of the 41 women with febrile complications (defined as fever equal to or above 38.0 C for more than 24 hours with no evidence of pneumonia, urinary tract infection, or nonreproductive infection) after tubal ligation, 8 (22%) were chlamydia-positive. Of note was the finding that 30% of chlamydia-negative women with febrile complications had a sexually transmitted disease history, predominantly chlamydia. Although previous studies have linked chlamydial infection with salpingitis, postabortion endometritis, tubal infertility, and ectopic pregnancy, this is the first to identify an association with febrile morbidity after postpartum tubal ligation. It cannot be ascertained whether the increased febrile complication rate is caused by chlamydia or concomitant conditions; nonetheless, use of rapid diagnostic tests in women intending to undergo postpartum tubal ligation and prompt treatment of chlamydial infections detected are recommended.