Assessing Risk of Post-Cesarean Endometritis and Implementing Vaginal Iodine Preparation in the High-Risk Pregnant Population: Quality Improvement and Risk Reduction Pilot Study

Matthew J Lenhard, MD, Hannah L Puckett, MS-3, Cheyenne Hammond, MS-2, James Cook, MD, Kamla Sanasi-Bhola, MD, Ivory Harding, MSBMS, Martin Durkin, MD, Kate Fisher, MD

There are >2,400 deliveries per year at our tertiary referral center (Prisma Health Midlands – PHM), which covers 16 counties in the midlands region of South Carolina. About 30% of the deliveries are cesarean, and we encounter infections daily, though our rate of endometritis is unknown. Post-partum endometritis is an ascending infection, similar to pelvic inflammatory disease, that affects approximately 1-3% of all deliveries (including vaginal deliveries, planned and unplanned cesarean deliveries).1 Cesarean delivery carries a 10-20-fold higher rate of infections (wound and uterine infection) compared to vaginal delivery.2 Many risk factors exist for postpartum endometritis including cesarean delivery, prolonged labor, prolonged rupture of membranes, multiple cervical exams, manual removal of placenta , low socioeconomic status, maternal diabetes mellitus or severe anemia, preterm or postterm birth, HIV infection, colonization with group B Streptococcus (GBS).3-5 A recent meta-analysis showed a 67% decrease in the rate of endometritis amongst high-risk patients (actively laboring and/or amniotomy before proceeding with cesarean) who received vaginal cleansing for > 30 seconds prior to delivery.6-7 Our study aims to determine the current rate of endometritis and demographic information of subjects in our cohort at PHM who were readmitted or treated post-operatively over a 12-month period, and compare the rate of post-op endometritis at our institution to other institutions or to published data.