PUERPERAL ENDOMETRITIS AFTER ABDOMINAL TWIN DELIVERY

The infectious complications of 122 consecutive abdominal twin deliver ies over the period 1984-1989 were analyzed in a prospective clinical study, comparing them with 761 singleton abdominal deliveries over the period 1984-1986. The incidence of endometritis was nearly three-fold after twin deliveries and the incidence of abdominal wound infections nearly two-fold compared with singleton abdominal pregnancies (13.1/4 .7% and 5.6/3.0%). The risk of amnionitis was increased ten-fold, 6 ho urs after rupture of the membranes in abdominal twin delivery, but no connection was found between amnionitis and endometritis, as in single ton abdominal deliveries. Multiple regression analysis indicated only two risk factors as regards puerperal endometritis after abdominal twi n delivery: age under 25 years (odds ratio 6.9, 95% confidence limits 1.9-24.8), an association also seen in singleton abdominal deliveries, and a period of more than 6 hours from rupture of membranes to delive ry (odds ratio 7.8, 95% confidence limits 2.1-28.5). Multiple pregnanc y appears to be associated with an increased risk of endometritis. The etiological factors remain unknown, but a large placental bed and/or immunological factors may be implicated.