Post-caesarean endometritis-myometritis (PCEM) was diagnosed in 49 Mozambican women. They were compared with 47 control women without signs of PCEM after caesarean section. The patients and controls were matched for age, parity and days post partum. Features of the socio-economic background and of past and current obstetric history were registered. Endocervical, intracavitary and blood cultures were carried out. Screening for syphilis seropositivity and HIV-1 and HIV-2 antibodies was performed. Socio-economic and obstetric background factors were similarly distributed in cases and referents, though previous caesarean section was less frequent among cases than among referents (OR 0.12). Moderate high-risk factors in existing antenatal card tended to be more frequent among cases than among referents (OR 3.29). Microbiological findings indicated more anaerobes in the vagina, in the endocervix and in the uterine cavity, though the differences only approached significance. It is concluded that women with PCEM in the setting studied expose few characteristic background features discriminating them from women with uneventful post-caesarean outcome. Further research efforts should be directed towards case-control studies with focus upon surgical factors and on a more comprehensive microbiology and serology approach.
PIP: A case control study included 49 women diagnosed with post-cesarean endometritis-myometritis (PCEM) and 47 controls who had also undergone a cesarean section but had no PCEM. Controls were matched with cases by age, parity, and days postpartum. All cases and controls delivered at Maputo Central Hospital in Mozambique. The study aimed to define potential background PCEM risk factors of socioeconomic and obstetric origin and serological and microbiological correlates. Health workers took blood samples, endocervical swabs, and intracavitary cultures from all cases and controls. They administered intraoperative prophylactic antibiotics to all cases and controls. Cases were more likely to live in a household of at least 6 persons (odds ratio [OR] = 4.44). Other socioeconomic factors studied were not significantly different between the 2 groups. Number of live births, stillbirths, abortions, and previous low birth weight deliveries were similar among both cases and controls. Cases were significantly less likely to have undergone a previous cesarean section than controls (OR = 0.12). Anaerobic bacteria were isolated more often from cases than controls in vaginal, endocervical, and intrauterine cultures (OR = 1.65, 1.95, and 1.77, respectively). Yet, the observed cultures were not significantly different between the 2 groups. Syphilis seropositivity and Chlamydia trachomatis rates were similar in cases and controls. These findings did not reveal any easily recognizable background risk factors for PCEM or any etiologic agent for PCEM. Additional case control studies are needed to focus on surgical factors. They also need to take on a more comprehensive microbiology and serology approach.