BACTEREMIA SHORTLY AFTER PLACENTAL SEPARATION DURING CESAREAN DELIVERY

Objective: To assess frequency, risk factors, and microbiology of bact eremia within 15 minutes of placental separation during cesarean deliv ery. Methods: Ninety-three women undergoing cesarean delivery after a minimum of 4 hours of labor or ruptured membranes were compared with 2 6 women not in labor undergoing cesarean. Blood cultures for aerobic a nd anaerobic bacteria were obtained within 15 minutes of delivery of t he placenta and before prophylactic antibiotic administration. Chorioa mnionic membranes were also cultured. Demographic, labor, delivery, an d postpartum characteristics were abstracted from the medical record. Results: Bacteremia was detected in 13 (11%) of 119 women. Bacteremia occurred in 13 (14%) of 93 women after labor or rupture of membranes c ompared with zero of 26 women not in labor (P = .02). Isolates include d group B streptococcus (n = 5), Gardnerella vaginalis (n = 5), Strept ococcus pneumoniae (n = 1), Peptostreptococcus sp (n = 1), and mixed f lora of Prevotella bivia, G vaginalis, and viridans streptococci (n = 1). Bacteremia was associated with earlier median gestational age, low er median birth weight, and a positive chorioamnionic membrane culture . After adjustment for gestational age, intrauterine monitoring was al so significantly associated with bacteremia. Conclusion: Bacteremia wa s common after labor in this population, especially in preterm deliver ies and those with positive chorioamnionic-placental culture. Many of the isolates are capable of causing endocarditis. Appraisal of the ris k of bacteremia and the risk of bacterial endocarditis should be made in individual patients to assess the need for antibiotic prophylaxis.