Correlation of laboratory and clinical criteria in the prediction of postcesarean endomyometritis.

The objective of this investigation was to develop a rapid diagnostic test to identify patients at exceptionally high risk for postcesarean endomyometritis. Intraoperative samples of endometrium, chorioamniotic membrane, and amniotic fluid were obtained from 70 patients undergoing nonelective cesarean section and were processed for bacterial culture, Gram stain, and histologic examination. Endomyometritis occurred in 57% of patients. Women with positive bacterial cultures (growth of high virulence organisms on the primary plates), positive Gram stains (bacteria in any oil immersion field), and histologic evidence of leukocytic infiltration in the chorioamniotic membrane and endometrium (greater than or equal to ten white blood cells per high-power field) were more likely than were patients with negative findings to develop endomyometritis. All of the laboratory tests evaluated were specific but insensitive predictors of infection. Assessment of duration of ruptured membranes and length of labor provided a diagnostic test that was as clinically useful in predicting postoperative infection as were any of the laboratory studies evaluated.