Clinical and microbiologic risk evaluation for post-cesarean section endometritis by multivariate discriminant analysis: role of intraoperative mycoplasma, aerobes, and anaerobes.

The clinical and microbiologic risk factors for postpartum endometritis were studied prospectively in 77 patients undergoing cesarean section without antibiotic prophylaxis at Harbor-University of California at Los Angeles Medical Center. Intraoperative cultures were obtained from the amniotic fluid, lower uterine segment, and abdominal wound for isolation of genital mycoplasmas, aerobes, and anaerobes. Postsection endometritis developed in 21 (27%) patients and was significantly associated with presence of either high-virulence bacteria (predominantly, coliforms, streptococci, anaerobic cocci, and bacteroides) (35% to 60% versus 10% to 24%; p less than 0.05) or Ureaplasma urealyticum (15% to 42% versus 0% to 10%; p less than 0.05) at any site compared with afebrile women. Multivariate analysis identified primary cesarean section, younger maternal age, presence of ruptured membranes, and presence of Ureaplasma as significant risk factors independent of other confounding variables (p less than 0.01). It is suggested that genital mycoplasmas could play a primary role in some cases of postsection endometritis or that they are cofactors or markers for the presence of other high-virulence aerobic and anaerobic bacteria.