ABSTRACT
A prospective blinded study was carried out on 80 patients undergoing cesarean delivery and receiving antibiotic prophylaxis. Amniotic fluid samples and decidual-myometrial biopsies were obtained at the time of the operation and examined to identify those incipiently infected patients. 15 patients developed post-cesarean endomyometritis and positive gram stain was detected only in eight of them. Significant histologic differences in decidual inflammation and myometrial polymorphonuclear cell invasion were detected in the group that developed post-cesarean endomyometritis compared with the group without endomyometritis. The patients who subsequently developed post-cesarean endomyometritis demonstrated greater numbers of bacteria in the myometrial biopsy compared with the group without endomyometritis as shown by acridine organ stain. These data showed that the technique of histologic detection of incipient infection and the detection of bacteria within the myometrial tissue provide accurate methods for the identification of the group at risk of development of post-cesarean endometritis