Extraperitoneal cesarean section: a surgical form of infection prophylaxis?

The suggestion that extraperitoneal cesarean section might be a useful method of preventing postoperative infectious complications prompted a prospective study of 91 primary extraperitoneal cesarean sections on afebrile laboring patients with ruptured membranes longer than 4 hours. Fifty of 91 patients having extraperitoneal cesarean sections (group A) were compared with 36 patients having low cervical transperitoneal primary cesarean sections (control group) meeting the same entry criteria in a prospective randomized fashion. The other 41 patients (group B = 25 of 41, group C = 16 of 41) were selected from qualifying high-risk patients depending on the availability of an experienced operator with group C receiving perioperative prophylactic antibiotics. The only significant difference in outcome was: four of 16 (25%) patients in group C (extraperitoneal cesarean section plus prophylactic antibiotics) developed postoperative endomyometritis versus 20 of 36 (56%), 28 of 50 (56%), and 12 of 25 (48%) patients in the transperitoneal primary cesarean section control group and extraperitoneal cesarean section group A and B, respectively (p less than 0.05). There was a trend toward enhanced postoperative recovery in all extraperitoneal cesarean section groups compared with the transperitoneal primary cesarean section control group. Thus, the technique of extraperitoneal cesarean section apparently offers no significant advantage in the prevention of postcesarean endomyometritis, but the use of perioperative prophylactic antibiotics apparently has significant impact.