ASSOCIATION OF POSTCESAREAN DELIVERY ENDOMETRITIS WITH COLONIZATION OF THE CHORIOAMNION BY UREAPLASMA-UREALYTICUM

Objective: To determine if asymptomatic antenatal colonization of the chorioamnion with Ureaplasma urealyticum is a risk factor for the deve lopment of post-cesarean delivery endometritis. Methods: The chorioamn ion was cultured at cesarean delivery for aerobic and anaerobic bacter ia, mycoplasmas, Chlamydia trachomatis, and Trichomonas vaginalis in 5 75 singleton gestations with intact membranes. Culture results were co mpared with the clinical outcome. Postoperative endometritis was defin ed as a temperature of 38C with uterine tenderness and without other n onpelvic sources of fever. Results: Fifty-eight (10%) of the 575 women developed endometritis. Women with spontaneous labor developed endome tritis twice as often as those delivered for medical or obstetric indi cations (17 versus 8%, P = .002). Endometritis occurred in 28% of wome n with U urealyticum present in the chorioamnion at cesarean delivery, compared with only 8.4% if the culture was negative and 8.8% if only bacteria other than ii urealyticum were isolated (P < .001). Gestation al age less than 34 weeks, spontaneous labor, and a vertical uterine i ncision were all associated with endometritis (P < .002). Regression a nalysis controlling for gestational age and incision type revealed a t hreefold increased risk of endometritis if the chorioamnion was coloni zed with U urealyticum at cesarean (odds ratio [OR] 3.0, 95% confidenc e interval [CI] 1.1-8.3) and an eightfold risk (OR 7.7, 95% CI 1.9-31. 5) in women in whom the onset of labor was spontaneous. Conclusion: Co lonization of the chorioamnion with U urealyticum in women with intact membranes being delivered by cesarean is a significant, independent p redictor of subsequent endometritis.