Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women

Ricardo Azziz, John Cumming, Richard Naeye

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Postoperative endomyometritis develops in as many as 85% of women undergoing cesarean section, which is 10- to 30-fold higher than after vaginal delivery. The timing and mechanism by which the infecting organisms gain access to the uterine cavity are unclear. One possibility is that the infection may occur postpartum by ascending colonization of the wound. Alternatively, myometritis may be already present at the time the cesarean section is performed in asymptomatic patients. With tissue necrosis, the stage is then set for puerperal endomyometritis. To study this second alternative mechanism, myometrial and placental biopsy specimens were obtained in 91 asymptomatic patients at the time of cesarean section. Histologic evidence of chorioamnionitis was identified in 10% ( 9 91) of patients. Acute myometritis was present in 11% ( 10 91) of the myometrial biopsy specimens. Seven of the nine women (77%) with subclinical acute chorioamnionitis demonstrated extension of the inflammation into the myometrium. Thirty-two percent ( 8 25) of women in labor and 31% ( 5 16) of those with rupture of membranes for >6 hours had acute chorioamnionitis or myometritis, which is significantly higher (p < 0.01) than in women without these risk factors. These findings suggest that approximately one third of asymptomatic women with rupture of the membranes for more than 6 hours or who are in labor at the time of cesarean section demonstrate histologic evidence of subclinical chorioamnionitis. In most of these patients the myometrium is also involved. The uterine incision is then performed through infected myometrium, possibly setting the stage for puerperal endomyometritis.

Original languageEnglish (US)
Pages (from-to)1137-1139
Number of pages3
JournalAmerican Journal of Obstetrics and Gynecology
Volume159
Issue number5
DOIs
StatePublished - Jan 1 1988

Fingerprint

Chorioamnionitis
Cesarean Section
Endometritis
Myometrium
Rupture
Biopsy
Membranes
Postpartum Period
Necrosis
Inflammation
Wounds and Injuries
Infection

Keywords

  • Myometritis
  • cesarean section
  • chorioamnionitis
  • endomyometritis

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women. / Azziz, Ricardo; Cumming, John; Naeye, Richard.

In: American Journal of Obstetrics and Gynecology, Vol. 159, No. 5, 01.01.1988, p. 1137-1139.

Research output: Contribution to journalArticle

Azziz, Ricardo ; Cumming, John ; Naeye, Richard. / Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women. In: American Journal of Obstetrics and Gynecology. 1988 ; Vol. 159, No. 5. pp. 1137-1139.
@article{43924548ff7b4fd19506221f8bda0b69,
title = "Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women",
abstract = "Postoperative endomyometritis develops in as many as 85{\%} of women undergoing cesarean section, which is 10- to 30-fold higher than after vaginal delivery. The timing and mechanism by which the infecting organisms gain access to the uterine cavity are unclear. One possibility is that the infection may occur postpartum by ascending colonization of the wound. Alternatively, myometritis may be already present at the time the cesarean section is performed in asymptomatic patients. With tissue necrosis, the stage is then set for puerperal endomyometritis. To study this second alternative mechanism, myometrial and placental biopsy specimens were obtained in 91 asymptomatic patients at the time of cesarean section. Histologic evidence of chorioamnionitis was identified in 10{\%} ( 9 91) of patients. Acute myometritis was present in 11{\%} ( 10 91) of the myometrial biopsy specimens. Seven of the nine women (77{\%}) with subclinical acute chorioamnionitis demonstrated extension of the inflammation into the myometrium. Thirty-two percent ( 8 25) of women in labor and 31{\%} ( 5 16) of those with rupture of membranes for >6 hours had acute chorioamnionitis or myometritis, which is significantly higher (p < 0.01) than in women without these risk factors. These findings suggest that approximately one third of asymptomatic women with rupture of the membranes for more than 6 hours or who are in labor at the time of cesarean section demonstrate histologic evidence of subclinical chorioamnionitis. In most of these patients the myometrium is also involved. The uterine incision is then performed through infected myometrium, possibly setting the stage for puerperal endomyometritis.",
keywords = "Myometritis, cesarean section, chorioamnionitis, endomyometritis",
author = "Ricardo Azziz and John Cumming and Richard Naeye",
year = "1988",
month = "1",
day = "1",
doi = "10.1016/0002-9378(88)90431-0",
language = "English (US)",
volume = "159",
pages = "1137--1139",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women

AU - Azziz, Ricardo

AU - Cumming, John

AU - Naeye, Richard

PY - 1988/1/1

Y1 - 1988/1/1

N2 - Postoperative endomyometritis develops in as many as 85% of women undergoing cesarean section, which is 10- to 30-fold higher than after vaginal delivery. The timing and mechanism by which the infecting organisms gain access to the uterine cavity are unclear. One possibility is that the infection may occur postpartum by ascending colonization of the wound. Alternatively, myometritis may be already present at the time the cesarean section is performed in asymptomatic patients. With tissue necrosis, the stage is then set for puerperal endomyometritis. To study this second alternative mechanism, myometrial and placental biopsy specimens were obtained in 91 asymptomatic patients at the time of cesarean section. Histologic evidence of chorioamnionitis was identified in 10% ( 9 91) of patients. Acute myometritis was present in 11% ( 10 91) of the myometrial biopsy specimens. Seven of the nine women (77%) with subclinical acute chorioamnionitis demonstrated extension of the inflammation into the myometrium. Thirty-two percent ( 8 25) of women in labor and 31% ( 5 16) of those with rupture of membranes for >6 hours had acute chorioamnionitis or myometritis, which is significantly higher (p < 0.01) than in women without these risk factors. These findings suggest that approximately one third of asymptomatic women with rupture of the membranes for more than 6 hours or who are in labor at the time of cesarean section demonstrate histologic evidence of subclinical chorioamnionitis. In most of these patients the myometrium is also involved. The uterine incision is then performed through infected myometrium, possibly setting the stage for puerperal endomyometritis.

AB - Postoperative endomyometritis develops in as many as 85% of women undergoing cesarean section, which is 10- to 30-fold higher than after vaginal delivery. The timing and mechanism by which the infecting organisms gain access to the uterine cavity are unclear. One possibility is that the infection may occur postpartum by ascending colonization of the wound. Alternatively, myometritis may be already present at the time the cesarean section is performed in asymptomatic patients. With tissue necrosis, the stage is then set for puerperal endomyometritis. To study this second alternative mechanism, myometrial and placental biopsy specimens were obtained in 91 asymptomatic patients at the time of cesarean section. Histologic evidence of chorioamnionitis was identified in 10% ( 9 91) of patients. Acute myometritis was present in 11% ( 10 91) of the myometrial biopsy specimens. Seven of the nine women (77%) with subclinical acute chorioamnionitis demonstrated extension of the inflammation into the myometrium. Thirty-two percent ( 8 25) of women in labor and 31% ( 5 16) of those with rupture of membranes for >6 hours had acute chorioamnionitis or myometritis, which is significantly higher (p < 0.01) than in women without these risk factors. These findings suggest that approximately one third of asymptomatic women with rupture of the membranes for more than 6 hours or who are in labor at the time of cesarean section demonstrate histologic evidence of subclinical chorioamnionitis. In most of these patients the myometrium is also involved. The uterine incision is then performed through infected myometrium, possibly setting the stage for puerperal endomyometritis.

KW - Myometritis

KW - cesarean section

KW - chorioamnionitis

KW - endomyometritis

UR - http://www.scopus.com/inward/record.url?scp=0024269698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024269698&partnerID=8YFLogxK

U2 - 10.1016/0002-9378(88)90431-0

DO - 10.1016/0002-9378(88)90431-0

M3 - Article

C2 - 3189448

AN - SCOPUS:0024269698

VL - 159

SP - 1137

EP - 1139

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 5

ER -