Can Clean Delivery Kits Prevent Infections? Lessons from Traditional Birth Attendants in Nigeria.

Background: In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria. Methods: The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests. Results: CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 -1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively. Conclusion: CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information.

Pre-Caesarean Section Vaginal Preparation with Chlorhexidine Solution in Preventing Puerperal Infectious Morbidities: A Randomized Controlled Trial.

BACKGROUND: Globally, peripartum or puerperal infections account for about one tenth of maternal mortality, most of which occur in low income countries. Therefore, vaginal preparation with an antiseptic prior to a caesarean delivery could be considered an additional measure to prevent subsequent infectious morbidities. OBJECTIVES: To evaluate vaginal preparation with 0.3% chlorhexidine solution in the prevention of endometritis, surgical site infection and post-operative fever following emergency caesarean section. METHODS: This prospective randomized controlled trial (RCT) was conducted among 240 participants planned for emergency caesarean sections (CS) at term in the University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria. Participants were randomised into either group "A" (study) or "B" (control). The former had vaginal preparation with 0.3% chlorhexidine gluconate immediately after anaesthesia while the latter received normal saline. Participants were followed up post-operatively during which clinical features of puerperal infectious morbidities were observed for each during admission as well as 8th and 14th days after delivery. RESULTS: The rate and risk of endometritis were significantly lower in the study group compared to the control; 5.0% versus 13.3%, respectively (chi squared =5.004; p=0.042, RR = 0.38; 95% CI = 0.15-0.94; p = 0.042; RRR = 0.62). Post-operative fever and surgical site infection, were also lower in the study group compared to the controls, but the difference was not statistically significant. CONCLUSION: When compared to placebo, pre-caesarean section vaginal preparation with 0.3% chlorhexidine solution significantly reduced only the rate and risk of post-operative endometritis among infectious morbidities.

CONTEXTE: À l'échelle mondiale, infections péripartum ou puerpérales représentent environ un dixième de la mortalité maternelle, dont la plupart se produisent dans les pays à faible revenu. Par conséquent, la préparation vaginale avec un antiseptique avant un accouchement par césarienne pourrait être considéré comme un mesure supplémentaire pour prévenir les morbidités infectieuses subséquentes. OBJECTIFS: Évaluer la préparation vaginale avec 0.3%solution de chlorhexidine dans la prévention de l'endométrite, site chirurgical infection et fièvre postopératoire après une césarienne d'urgence section. MÉTHODES: Cet essai prospectif randomisé contrôlé (ECR)a été menée auprès de 240 participants prévus pour une urgence césariennes (CS) à terme à l'Université des sciences médicales Complexe hospitalier universitaire, État d'Ondo, Nigéria. Les participants étaient randomisé dans le groupe "A" (étude) ou "B" (témoin). Celui-là avait une préparation vaginale avec 0.3 % de gluconate de chlorhexidine immédiatement après l'anesthésie alors que ce dernier a reçu une solution saline normale. Les participants ont été suivis postopératoirement au cours desquels des caractéristiques de morbidité infectieuse puerpérale ont été observées pour chaquelors de l'admission ainsi que les 8ème et 14ème jours après la livraison. RÉSULTATS: Le taux et le risque d'endométrite étaient significativement plus faibles dans le groupe d'étude par rapport au groupe témoin; 5.0 % contre 13.3 %, respectivement (chi carré =5.004; p=0.042, RR = 0.38; 95% CI = 0.15­0.94; p = 0.042; RRR = 0.62). Fièvre postopératoire et infection du site chirurgical, étaient également plus faibles dans le groupe d'étude par rapport aux témoins, mais lela différence n'était pas statistiquement significative. CONCLUSION: Par rapport au placebo, pré-césarienne préparation vaginale avec une solution de chlorhexidine à 0.3% significativement réduit uniquement le taux et le risque d'endométrite postopératoire chez morbidités infectieuses. Mots-clés: Chlorhexidine, Préparation Vaginale, Infection Puerpéral emorbidité, Césarienne, Endométrite, Fièvre Postopératoire, Infection Du Site Chirurgical.

Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections.

OBJECTIVES: Gestational IDA has been linked to adverse maternal and neonatal outcomes, but the impact of iron supplementation on outcome measures remains unclear. Our objective was to assess the effects of gestational IDA on pregnancy outcomes and compare outcomes in pregnancies treated with either oral or intravenous iron supplementation. METHODS: We evaluated maternal and neonatal outcomes in 215 pregnancies complicated with gestational IDA (Hb<100 g/L) and delivered in our tertiary unit between January 2016 and October 2018. All pregnancies from the same period served as a reference group (n=11,545). 163 anemic mothers received oral iron supplementation, and 52 mothers received intravenous iron supplementation. RESULTS: Gestational IDA was associated with an increased risk of preterm birth (10.2% vs. 6.1%, p=0.009) and fetal growth restriction (FGR) (1.9% vs. 0.3%, p=0.006). The gestational IDA group that received intravenous iron supplementation had a greater increase in Hb levels compared to those who received oral medication (18.0 g/L vs. 10.0 g/L, p<0.001), but no statistically significant differences in maternal and neonatal outcomes were detected. CONCLUSIONS: Compared to the reference group, prematurity, FGR, postpartum infections, and extended hospital stays were more common among mothers with gestational IDA, causing an additional burden on the families and the healthcare system.

Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal.

BACKGROUND: Globally, puerperal sepsis accounts for an estimated 8-12% of maternal deaths, but evidence is lacking on the extent to which clean delivery practices could improve maternal survival. We used data from the control arms of four cluster-randomised controlled trials conducted in rural India, Bangladesh and Nepal, to examine associations between clean delivery kit use and hand washing by the birth attendant with maternal mortality among home deliveries. METHODS: We tested associations between clean delivery practices and maternal deaths, using a pooled dataset for 40,602 home births across sites in the three countries. Cross-sectional data were analysed by fitting logistic regression models with and without multiple imputation, and confounders were selected a priori using causal directed acyclic graphs. The robustness of estimates was investigated through sensitivity analyses. RESULTS: Hand washing was associated with a 49% reduction in the odds of maternal mortality after adjusting for confounding factors (adjusted odds ratio (AOR) 0.51, 95% CI 0.28-0.93). The sensitivity analysis testing the missing at random assumption for the multiple imputation, as well as the sensitivity analysis accounting for possible misclassification bias in the use of clean delivery practices, indicated that the association between hand washing and maternal death had been over estimated. Clean delivery kit use was not associated with a maternal death (AOR 1.26, 95% CI 0.62-2.56). CONCLUSIONS: Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

Postparturient disorders and backfat loss in tropical sows associated with parity, farrowing duration and type of antibiotic.

The present study investigated the incidence of postparturient disorders and backfat loss in primiparous and multiparous sows under tropical climates in relation to duration of farrowing and type of antibiotic used postpartum. In total, 81 sows (42 primiparous and 39 multiparous sows) were included. The sows were categorised according to the duration of farrowing into three groups: <2 (n = 58), 2-4 (n = 19) and >4 h (n = 4). According to the antibiotic used postpartum, the sows were divided into two groups: group I (enrofloxacin type 1, n = 36) and group II (enrofloxacin type 2, n = 45). Rectal temperature, the presence of abnormal vaginal discharge, the occurrence of postpartum dysgalactia syndrome (PDS) and the sows' appetite were determined at days 0, 1, 2 and 3 postpartum. Backfat thickness was measured before farrowing and at 21 days postpartum. The mean duration of farrowing was 114.5 ± 60.2 min. Stillborn piglets in the sows with a long duration of farrowing (>4 h, mean 287.9 min) was higher than in sows with a short duration (<2 h, mean 85.5 min) of farrowing (29.2 and 7.9 %, P = 0.044). Primiparous sows lost more backfat during lactation than multiparous sows (15.7 and 4.8 %, P = 0.004). The incidence of abnormal vaginal discharge (P = 0.046) and PDS (P = 0.057) was less frequent in group II than in group I sows. In conclusion, primiparous sows and sows with a long duration of farrowing had a high risk of postparturient disorders. The type of antibiotic had an effect on the incidence of abnormal vaginal discharge and PDS in sows.

Enemas during labour.

BACKGROUND: Although the use of enemas during labour usually reflects the preference of the attending healthcare provider, enemas may cause discomfort for women. OBJECTIVES: To assess the effects of enemas applied during the first stage of labour on maternal and neonatal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2013, Issue 5), PubMed (1966 to 31 May 2013), LILACS (31 May 2013), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (31 May 2013), Health Technology Assessment Program, UK (31 May 2013), Medical Research Council, UK (31 May 2013), The Wellcome Trust, UK (31 May 2013) and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. MAIN RESULTS: Four RCTs (1917 women) met the inclusion criteria. One study was judged as having a low risk of bias. In the meta-analysis we conducted of two trials, we found no significant difference in infection rates for puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% confidence (CI) 0.42 to 1.04). No significant differences were found in neonatal umbilical infection rates (two RCTs; 592 women; RR 3.16, 95% CI 0.50 to 19.82; I(2) 0%. In addition, meta-analysis of two studies found that there were no significant differences in the degree of perineal tear between groups. Finally, meta-analysis of two trials found no significant differences in the mean duration of labour. AUTHORS' CONCLUSIONS: The evidence provided by the four included RCTs shows that enemas do not have a significant beneficial effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. These findings speak against the routine use of enemas during labour, therefore, such practice should be discouraged.

Enemas during labour.

BACKGROUND: Although the use of enemas during labour usually reflects the preference of the attending healthcare provider, enemas may cause discomfort for women. OBJECTIVES: To assess the effects of enemas applied during the first stage of labour on maternal and neonatal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 May 2012), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2012, Issue 5), PubMed (1966 to 17 May 2012), LILACS (17 May 2012), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (17 May 2012), Health Technology Assessment Program, UK (17 May 2012), Medical Research Council, UK (17 May 2012), The Wellcome Trust, UK (17 May 2012) and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion.  MAIN RESULTS: Four RCTs (1917 women) met the inclusion criteria. One study was judged as having a low risk of bias. In the meta-analysis we conducted of two trials, we found no significant difference in infection rates for puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% confidence (CI) 0.42 to 1.04). No significant differences were found in neonatal umbilical infection rates (two RCTs; 592 women; RR 3.16, 95% CI 0.50 to 19.82; I² 0%. In addition, meta-analysis of two studies found that there were no significant differences in the degree of perineal tear between groups. Finally, meta-analysis of two trials found no significant differences in the mean duration of labour. AUTHORS' CONCLUSIONS: The evidence provided by the four included RCTs shows that enemas do not have a significant beneficial effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. These findings speak against the routine use of enemas during labour, therefore, such practice should be discouraged.

Vigilance must be a priority: maternal genital tract sepsis.

Although very rare in the UK, sepsis was the leading cause of direct maternal deaths during 2006-2008, with an increase in community acquired Group A streptococcal infection (CMACE 2011). Most deaths occurred in the postnatal period and were often preceded by a sore throat or other upper respiratory infection, with a clear seasonal pattern. An associated factor was women of BME origin (black or minority ethnic origin). More than half of the deaths followed birth by caesarean section. All antenatal and postnatal women should be offered advice on the signs and symptoms of life threatening conditions, including sepsis. Information should include the importance of good hand and perineal hygiene and of the need to seek immediate medical care if feeling unwell. Relevant NICE guidance should be disseminated and implemented as widely as possible. Greater priority should be given to ensuring all women, particularly those in the most vulnerable groups, are aware of how to access timely and appropriate care.

Impact of clean delivery kit use on clean delivery practices in Beni Suef Governorate, Egypt.

OBJECTIVE: A major factor contributing to neonatal and maternal infections is unhygienic delivery practices. This study explores the impact of clean delivery kit (CDK) use on clean delivery practices during home and facility deliveries. DESIGN: Kits were distributed from primary care facilities and mothers and birth attendants received training on kit importance and use. The study was designed as a cross-sectional cohort study. Raedat (community health workers) visited 349 women during the postpartum period to administer a structured questionnaire. SETTING: The study was conducted from mid-March through mid-July 2001 in two rural areas of Ihnasia district in Beni Suef Governorate (Upper Egypt). RESULT: In bivariate analysis, CDK users in the home were more likely to report that the birth attendant had clean hands (P<0.001), washed/wiped the mother's perineum (P<0.001), used a sterile cord tie (P=0.001), applied antiseptic to the cord after cutting (P<0.001), and used a sterile cord cover (P<0.001) as compared with non-CDK users. CDK users at the facility were more likely to report that the birth attendant washed/wiped the mothers perineum (P=0.049) and used a sterile cord cover (P=0.030) as compared with non-CDK users. CONCLUSION: In settings in which unhygienic practices during home as well as facility deliveries are prevalent, use of inexpensive CDKs can promote clean delivery practices.

Impact of clean delivery-kit use on newborn umbilical cord and maternal puerperal infections in Egypt.

This cross-sectional cohort study explored the impact of the use of clean delivery-kit (CDK) on morbidity due to newborn umbilical cord and maternal puerperal infections. Kits were distributed from primary-care facilities, and birth attendants received training on kit-use. A nurse visited 334 women during the first week postpartum to administer a structured questionnaire and conduct a physical examination of the neonate and the mother. Results of bivariate analysis showed that neonates of mothers who used a CDK were less likely to develop cord infection (p = 0.025), and mothers who used a CDK were less likely to develop puerperal sepsis (p = 0.024). Results of multiple logistic regression analysis showed an independent association between decreased cord infection and kit-use [odds ratio (OR) = 0.42, 95% confidence interval (CI) 0.18-0.97, p = 0.041)]. Mothers who used a CDK also had considerably lower rates of puerperal infection (OR = 0.11, 95% CI 0.01-1.06), although the statistical strength of the association was of borderline significance (p = 0.057). The use of CDK was associated with reductions in umbilical cord and puerperal infections.

Use of a clean delivery kit and factors associated with cord infection and puerperal sepsis in Mwanza, Tanzania.

Our objective was to determine the effectiveness of an intervention that incorporated education about the "six cleans" with the use of a clean delivery kit in preventing cord infection and puerperal sepsis. A stepped-wedge, cross-sectional study was conducted in 10 surveillance sites across two rural districts of Mwanza Region, Tanzania. A total of 3262 pregnant women between the ages of 17 and 45 years were enrolled in the study. Village health workers administered questionnaires to each mother at 5 days postpartum and inspected the infants' umbilical cord stumps for signs of infection. Newborns whose mothers used the delivery kit were 13.1 times less likely to develop cord infection than infants whose mothers did not use the kit. Furthermore, women who used the kit for delivery were 3.2 times less likely to develop puerperal sepsis than women who did not use the kit. Women who bathed before delivery were 2.6 times less likely to develop puerperal sepsis than women who did not bathe, and their infants were 3.9 times less likely to develop cord infection. Single-use delivery kits, when combined with education about clean delivery, can have a positive impact on the health of women and their newborns by significantly decreasing the likelihood of developing puerperal sepsis or cord infection.

Puerperal sepsis and maternal mortality: what role can new technologies play?

OBJECTIVE: To identify new and underutilized technologies to reduce maternal mortality related to puerperal sepsis in developing countries. METHOD: Review of current medical literature. RESULT: The literature indicates that infection-control protocols and evidence-based procedures--including prophylactic antibiotics for cesarean section or preterm rupture of membranes, and updated antibiotic regimens--should be widely adopted. Devices such as hand rubs, needle-disposal systems, and rapid microbiological diagnostic tests can improve compliance and efficiency. Operational research on promising developments like vaginal cleansing with antiseptics, vitamin A supplementation, and prophylactic antibiotics in high-risk women is needed. CONCLUSION: Sepsis management continues to depend on good implementation of established technologies. Program-based approaches are required to improve uptake.

Nutrition and maternal morbidity and mortality.

Nearly 600 000 women die every year from pregnancy related conditions and the maternal mortality rates (MMR = deaths per 100 000 live births) in developing countries may be as high as 1000 compared with less than ten in industrialised countries. In the light of the striking impact of deficiencies of micronutrients such as vitamin A and zinc on immune function, morbidity and mortality in children it seems reasonable to suggest that such deficiencies might play a contributing role in the high rates of morbidity and mortality in mothers. Hitherto, there has been rather little published on the contribution of malnutrition to maternal morbidity or mortality but recent results of micronutrient supplementation show a major effect of vitamin A or beta carotene supplementation on maternal mortality in Nepal and an impressive effect of a multiple micronutrient mixture on pregnancy outcome in Tanzania. There is now data showing that subclinical mastitis, a potential risk factor for mother to child transmission of HIV by increasing levels of virus in breast milk, is influenced by maternal diet in Tanzania and feeding patterns in South Africa. Considering the massive tragedy of maternal mortality the recent data provides opportunities for new, innovative nutritional interventions for the reduction of the global burden of maternal morbidity and mortality.

Training traditional birth attendants in clean delivery does not prevent postpartum infection.

OBJECTIVE: To compare the maternal outcome, in terms of postpartum infection, of deliveries conducted by trained traditional birth attendants (TBAs) with those conducted by untrained birth attendants. METHODS: The study took place in a rural area of Bangladesh where a local NGO (BRAC) had previously undertaken TBA training. Demographic surveillance in the study site allowed the systematic identification of pregnant women. Pregnant women were recruited continuously over a period of 18 months. Data on the delivery circumstances were collected shortly after delivery while data on postpartum morbidity were collected prospectively at 2 and 6 weeks. All women with complete records who had delivered at home with a non-formal birth attendant (800) were included in the analysis. The intervention investigated was TBA training in hygienic delivery comprising the 'three cleans' (hand-washing with soap, clean cord care, clean surface). The key outcome measure was maternal postpartum genital tract infection diagnosed by a symptom complex of any two out of three symptoms: foul discharge, fever, lower abdominal pain. RESULTS: Trained TBAs were significantly more likely to practice hygienic delivery than untrained TBAs (45.0 vs. 19.3%, p < 0.0001). However, no significant difference in levels of postpartum infection was found when deliveries by trained TBAs and untrained TBAs were compared. The practice of hygienic delivery itself also had no significant effect on postpartum infection. Logistic regression models confirmed that TBA training and hygienic delivery had no independent effect on postpartum outcome. Other factors, such as pre-existing infection, long labour and insertion of hands into the vagina were found to be highly significant. CONCLUSIONS: Trained TBAs are more likely to practice hygienic delivery than those that are untrained. However, hygienic delivery practices do not prevent postpartum infection in this community. Training TBAs to wash their hands is not an effective strategy to prevent maternal postpartum infection. More rigorous evaluation is needed, not only of TBA training programmes as a whole, but also of the effectiveness of the individual components of the training.

Mastitis today: incidence, prevention and treatment.

The study concerned 664 women of South-West Finland, and they were studied 5-12 weeks after delivery. The total frequency of mastitis in this population was much higher than generally reported in literature, 24% as opposed to 3%. The frequency of mastitis was similar among nulli- and multiparous women. The diagnosis was based on the judgement of midwives of physicians. If a multiparous woman has had mastitis during a previous puerperium, the probability of mastitis during a subsequent puerperium is threefold. The type of skin, its reaction of the sun, allergies, rashes, getting cold and oxytocin medication during delivery did nto affect the incidence of mastitis. Mothers under 21 and over 35 years of age had a decreased incidence (P = 0.034) of mastitis. If the women had sore nipples, the frequency increased (P = 0.003). Prophylaxis, by means of physical training, neither decreased nor increased the frequency of puerperal mastitis. The treatment advised by midwives and physicians was primarily conservative, but 38% received antibiotics; some of the antibiotics were not effective against staphylococcal infection.

The conquest of cesarean section-related infections: a progress report.

More than a century ago, Robert P. Harris demonstrated convincingly that death from infection after cesarean section could be reduced significantly by operating early, rather than after several days of labor, by using aseptic surgical technique, and by closing the uterine incision. For the most part, his advice was ignored and the mortality rate remained high, except in hospitals with well-organized and well-controlled obstetric services. Although the incidence of total infections has been decreased by the use of prophylactic antibiotics, too many serious infections and maternal deaths still occur. These can be reduced by proper management of labor, by recognizing the need for cesarean section early, by using alternative methods for delivery when appropriate, by meticulous surgical technique, and by selective use of prophylactic antibiotics. These changes are not likely to occur unless care of obstetric patients is assumed by experienced obstetricians who are prepared to recognize and correct abnormal labor early and to perform instrumental extraction and vaginal breech deliveries rather than cesarean section in carefully selected patients.

[Maternal morbidity following cesarean section: effect of infection control and preventive use of antibiotics]. / Mütterliche Morbidität nach Sectio: Einfluss von Infektionskontrolle und Antibiotikaprophylaxe.

1. Between 1976 and 1986, data were collected prospectively by a nurse specializing in hygiene on postoperative infections in the 3508 low cervical cesarean sections carried out at the University Gynecological Clinic in Tübingen. Over the past four years, this has also included data on noninfectious complications. During this 11-year period, the rate of sections rose from 10.3% to 18.2%. 2. During the first seven years, in which only hygienic, organizational, and surgical measures were used to prevent infection, the rate of patients with postoperative infections decreased from 28.2% to 11.9% (-58%), while the rate of feverish standard morbidity decreased from 27.2% to 9.7% (-64%). 3. Over the past four years, in which 60% of the patients received a perioperative antibiotics prophylaxis consisting of three doses of a cephalosporin, the number of patients with infections has decreased further to 8.6% (-28%), and the number of those with feverish morbidity to 3.7% (-62%). Over the total period, the reduction in the named parameters was 70% and 86%. 4. The most frequent infections were urinary tract infections (mainly cases of asymptomatic bacteriuria), infections of the abdominal wound, and endomyometritis and phlebitis of the arm owing to intravenous applications. Only the reductions in the number of cases of bacteriuria (-77%), wound infections (-72%), and endomyometritis (-73%) reached statistic significance. 5. As a result of antibiotics prophylaxis, the rate of infections in the case of primary section decreased from 15.3% to 9.0%, and in the case of secondary section from 15.1% to 8.2%; feverish standard morbidity decreased from 9.1% to 3.5% and from 9.4% to 4.9%.(ABSTRACT TRUNCATED AT 250 WORDS)