Methods
A retrospective review was performed from January 1, 2013 through December 31, 2013 at a multi-center tertiary care institution. Statistical analysis for categorical and continuous covariates were assessed using Chi Square and student’s t-test respectively, and regression models were used to identify risk factors.
Results
Of the 2419 patients included in the analysis, 38 patients were diagnosed with PPE (1.6%). On multivariate analysis adjusting for confounders, rates of PPE were higher for emergent CD vs. scheduled CD (OR 5.89; 95% CI 1.58-21.91; p = 0.0081). Those with low transverse uterine incisions had lower rates of PPE compared to those with classical incisions (OR 0.19; 95% CI 0.05-0.68; p = 0.01). Rates of PPE were not significantly different for patients who received cefazolin 2g vs. 1g (OR 1.91; 95% CI 0.77-4.77; p=0.17) and cefazolin 3g vs. 1g (OR 3.69; 95% CI 0.34-40.70; p=0.29). However, patients who received gentamicin 1.5mg/kg and clindamycin 600mg had significantly higher rates of PPE compared to cefazolin 1g (OR 5.60; 95% CI 2.01-15.56; p<0.001) and this was also true for those who received other antibiotic regimens (OR 9.68; 95% CI 2.47-37.85; p=0.001). Patients who had cesarean section for arrest of labor had significantly higher rates of PPE (OR 4.336; 95% CI 1.74-10.80; p = 0.001). Women with PPE were more likely to have pregnancy complicated by STI (OR 4.197; 95% CI 1.21-14.5; p=0.02), PPROM (OR 4.89; 95% CI 1.44-16.66; p=0.01) or be of older age (for each year – OR 0.904, 95% CI 0.85-0.97; p = 0.002). Blood transfusion was significantly associated with PPE (OR 9.50; 95% CI 3.50-25.80; p<0.0001).
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