Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Table 2 Interventions and techniques surrounding cesarean delivery

	Wound infection		Endometritis
Variables	RR or OR	References	RR or OR	References
Preoperative elements
First generation cephalosporin vs. none	0.38	34	0.42	34
First generation cephalosporin prior to skin incision vs. after cord clamp	0.7	11, 35-38	0.21-0.61	11, 35-38
First generation cephalosporin 2 g vs. 3 g in morbidly obese women	NS	40	-	-
Azithromycin
In labor	0.35	9	0.62	9
Non labor	-	-	0.11	41
Chlorhexidine alcohol skin preparation vs. iodine	0.55	42, 43	NS	42
Razor hair removal vs. clippers	2.1	44	-	-
Vaginal cleansing
Chlorhexidine vs none	NS	45	0.2	45
Iodine vs none	NS	10, 18, 46, 47	0.39	10, 18, 46, 47
In labor	NS	47	NS	47
Not in labor	NS	47	NS	47
Ruptured membranes	NS	46, 47	0.13	46, 47
Intact membranes	NS	47	NS	47
Intraoperative elements
Uterine exteriorization	NS	49	NS	49
Manual removal of placneta vs. traction of umbilical cord	-	-	1.4-1.6	50, 51
Intraabdominal irrigation	NS	53	NS	52, 53
Closure of subcutaneous tissue if >2 cm^a	NS	54	-	-
Subcutaneous drain	NS	55, 56	-	-
Suture skin closure vs. staple^b	NS	6, 57, 58	-	-
Postoperative elements
Dressing removal between 24 and 48 h vs. 6 h	NS	7	-	-

RR relative risk; OR odds ratio; NS not statistically significant; CI confidence interval
^aWound complications (hematoma, seroma, and infection) - RR 0.66; 95%CI 0.48, 0.91; Wound separation - RR 0.42; 95%CI 0.24, 0.75
^bWound complications (wound infection, hematoma, seroma, or separation of 1 cm or longer) -adjusted OR 0.43; 95%CI 0.23, 0.78; wound separation - adjusted OR 0.20; 95%CI 0.07, 0.51