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Am J Obstet Gynecol. 2014 Oct;211(4):410.e1-6. doi: 10.1016/j.ajog.2014.03.040. Epub 2014 Mar 18.

Infectious morbidity is higher after second-stage compared with first-stage cesareans.

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  • 1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO. Electronic address:
  • 2Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.



The objective of the study was to compare maternal and neonatal infectious morbidity following cesareans performed in the second and first stages of labor.


We conducted a retropective cohort study of all consecutive, singleton, term, cesarean deliveries in laboring women in a single institution from 2005 to 2012. Second-stage cesareans were defined as those performed at complete cervical dilation (10 cm), and first-stage cesareans were those performed before 10 cm cervical dilation. The primary outcome was endometritis. Rates of infectious morbidity were compared in the 2 groups. Multivariable logistic regression was used to calculate adjusted risk estimates.


Of 2505 cesareans meeting inclusion criteria, 400 (16.0%) were performed in the second stage, whereas 2105 (84.0%) were performed in the first stage of labor. The risk of endometritis was nearly 3-fold higher in second- compared with first-stage cesareans (4.25% vs 1.52%; crude odds ratio, 2.88; 95% confidence interval, 1.58-5.23). The risk remained significantly higher after controlling for confounders (adjusted odds ratio, 2.78; 95% confidence interval, 1.51-5.09).


Second-stage cesarean is associated with an increased risk of endometritis compared with first-stage cesarean. Further studies will determine whether different infection preventive strategies are needed at second-stage cesareans to reduce endometritis.

Copyright © 2014 Elsevier Inc. All rights reserved.


cesarean; first stage; infections; labor; second stage

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[Available on 2015-10-01]
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