Fixler Joseph S
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
Arch Gynecol Obstet. 2024 Aug;310(2):1049-1053. doi: 10.1007/s00404-024-07384-7. Epub 2024 Mar 6.
The relationship between multifetal cesarean delivery and surgical-site infection (SSI) is unclear. If SSI is more common in multifetal cesareans, adjustment of practices such as antibiotic dosing could be warranted. The purpose of this study was to determine whether patients undergoing multifetal cesarean delivery are more likely to experience SSI than those undergoing singleton cesarean delivery.
This was a retrospective cohort study including all cesarean deliveries at a tertiary hospital from 10/1/2009 to 12/28/2018. The primary outcome was rate of SSI in women after multifetal cesarean delivery as compared to those who underwent singleton cesarean delivery. Univariable analysis and multivariable logistic regression were used to assess independent clinical factors associated with SSI in multifetal cesarean deliveries.
34,340 women underwent cesarean delivery during this period. 33,211 were singletons (96.7%), and 1,129 were multifetal (3.3%). There was no difference in the rate of SSI in multifetal gestations (15/1,129, 1.3%) as compared to singletons (493/33,211, 1.5%) (p = 0.670, OR 0.89 [95% CI 0.53, 1.50], aOR 1.06 [95% CI 0.61, 1.84]). Limiting analysis to multifetal deliveries, prolonged rupture of membranes (p < 0.004, OR 5.43 [95% CI 1.49, 19.88]), labor augmentation (p < 0.001, OR 15.84 [1.74, 144.53]), and chorioamnionitis (p < 0.001, OR 15.43 [95% CI 3.11, 76.62]) were more common in women with SSI.
SSI is not increased in multifetal cesarean delivery as compared to singleton cesarean delivery. In multifetal cesareans, chorioamnionitis, prolonged rupture of membranes, and labor augmentation were associated with increased odds of SSI.
多胎剖宫产与手术部位感染（SSI）之间的关系尚不清楚。如果SSI在多胎剖宫产中更为常见，那么调整抗生素剂量等做法可能是必要的。本研究的目的是确定接受多胎剖宫产的患者是否比接受单胎剖宫产的患者更容易发生SSI。
这是一项回顾性队列研究，纳入了2009年10月1日至2018年12月28日在一家三级医院进行的所有剖宫产。主要结局是多胎剖宫产术后女性的SSI发生率与单胎剖宫产术后女性的SSI发生率的比较。采用单因素分析和多因素逻辑回归来评估与多胎剖宫产中SSI相关的独立临床因素。
在此期间，34340名女性接受了剖宫产。其中33211名为单胎（96.7%），1129名为多胎（3.3%）。多胎妊娠的SSI发生率（1129例中的15例，1.3%）与单胎妊娠的SSI发生率（33211例中的493例，1.5%）相比无差异（p = 0.670，OR 0.89 [95% CI 0.53, 1.50]，校正OR 1.06 [95% CI 0.61, 1.84]）。将分析局限于多胎分娩，胎膜早破时间延长（p < 0.004，OR 5.43 [95% CI 1.49, 19.88]）、引产（p < 0.001，OR 15.84 [1.74, 144.53]）和绒毛膜羊膜炎（p < 0.001，OR 15.43 [95% CI 3.11, 76.62]）在发生SSI的女性中更为常见。
与单胎剖宫产相比，多胎剖宫产的SSI并未增加。在多胎剖宫产中，绒毛膜羊膜炎、胎膜早破时间延长和引产与SSI发生几率增加相关。
