Pre-existing anemia and the number of vaginal examinations as predisposing factors for puerperal infection

The purpose of this study was to determine (a) if there was a relationship between the number of vaginal examinations on patients in labor and the incidence of puerperal morbidity, and (b) if there was a relationship between pre-existing anemia and puerperal morbidity. It was hypothesized that an increased number of vaginal examinations or the presence of anemia would be associated with a higher incidence of puerperal morbidity. Hospital records of 240 maternity patients at the University of Utah Medical Center were surveyed. This included a two-month survey from June 1, 1966 to August 19, 1966, and a two-month retrospective study for 1965. The two time periods were similar in season and number of deliveries. Women were selected for the study who had had normal antepartum course and a normal temperature on admission. Women were excluded form the study if (a) labor was longer than 24 hours, (b) the membranes had been ruptured prior to the onset of labor, (c) hemorrhage/ and or unusual trauma during labor, delivery or postpartum occurred, (d) the placenta was manually removed, or (e) the delivery was by Caesarian section. The data revealed a 28.7% febrility rate for 1965 and 11.4% febrility rate for 1966. This difference is rate was not significant. There was not significant relationship between the number of vaginal examinations and puerperal morbidity for either year. Thus the hypothesis that puerperal morbidity would be associated with a higher number of vaginal examinations was not supported. The number of anemic patients who became febrile was 33.3% for 1965 and 5.5% for 1966. The difference between these percentages was significant at the .01 level. The 1965 data supported Bickerstaff's findings that pre-existing anemia was positively associated with the incidence or puerperal morbidity. However, this relationship was not found in the 1966 data.