Post Cesarean Section Pelvic Abscess: Case-Control Study And Lessons Learned Following An Outbreak At A Tertiary Care Teaching Hospital

Objectives: To study the risk factors for pelvic abscess following cesarean section. Design: Case-control study with two-tailed univariate analysis of potential risk factors and multiple logistic regression to test the combined effects of these risk factors. Setting: Tertiary care teaching hospital in Jeddah, Saudi Arabia. Participants: 21 women with pelvic abscess following cesarean section and 21 matched controls who underwent cesarean section during the same time period but experienced no known surgical site infections. Risk factors considered: Body mass index (BMI), diabetes mellitus (DM) and hypertension, type of cesarean section (elective vs. emergency), number of previous cesarean sections, allocation to labor and delivery ward, timing of rupture of the membrane, antibiotic prophylaxis, and number of per-vaginal examinations before cesarean section. Results: All risk factors except hypertension and antibiotic prophylaxis were significant (p between 0.0001-0.05 based on Chisquare test) in the univariate analysis. In the multiple logistic regression analysis, the number of vaginal examinations (19/21 in cases vs. 11/21 in controls, odds ratio (OR) 8.6, 95% confidence interval (CI) 1.59-46.8, p = 0.01 based on student T test) and emergency cesarean section (17/21 vs. 9/21, OR 5.7, 95% CI 1.41-22.8, p = 0.01) resulted in the highest odds ratios, although allocation to the labor and delivery ward emerged as the statistically most significant risk factor (21/21 vs. 11/21, OR 2.0, 95% CI 1.27-2.87, p = 0.0001) Conclusions: Identification of the main risk factors will help prioritize appropriate infection control measures to those at highest risk of pelvic abscess following cesarean section