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Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):159-165
DOI 10.1590/S0100-72032000000300007
Purpose: to determine the frequency of recurrence of seizures after anticonvulsant therapy with magnesium sulfate and to evaluate treatment and maternal prognosis. Patients and Methods: a prospective cohort study was conducted, enrolling all cases of eclampsia managed at IMIP between January/1995 and June/1998. Magnesium sulfate and oxygen therapy were administered routinely and interruption of pregnancy was performed after maternal stabilization. The frequency of recurrence of seizures and its association with maternal complications were determined. chi² test for association was used at a 5% level of significance. Results: twelve cases presented recurrence of convulsions after magnesium sulfate (10%) and all received a repeated dose. In four of them convulsions persisted and they received intravenous diazepam. After diazepam, one patient still had seizures, with unsuccessful administration of phenytoin and therefore barbituric coma was induced (thionembutal). This patient had a CT-scan with evidence of intracerebral hemorrhage. Maternal complications were significantly more frequent in the group with recurrence: coma (16.7% versus 0.95), acidosis (50% versus 2.9%), pulmonary edema (16.7% versus 2.9%), cerebral hemorrhage (16.7% versus 0%) and acute renal failure (16.7% versus 1.9%). Three cases of maternal death occurred in patients with recurrence (25%) versus 2 cases in patients without recurrence (1.9%). Conclusions: rate of recurrence after anticonvulsant therapy with magnesium sulfate is low (10%) but it is associated with increased maternal morbidity and mortality. These cases must be managed in an intensive care unit and submitted to routine CT-scan because cerebral hemorrhage can be the cause of recurrence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):159-165
DOI 10.1590/S0100-72032000000300007
Purpose: to determine the frequency of recurrence of seizures after anticonvulsant therapy with magnesium sulfate and to evaluate treatment and maternal prognosis. Patients and Methods: a prospective cohort study was conducted, enrolling all cases of eclampsia managed at IMIP between January/1995 and June/1998. Magnesium sulfate and oxygen therapy were administered routinely and interruption of pregnancy was performed after maternal stabilization. The frequency of recurrence of seizures and its association with maternal complications were determined. chi² test for association was used at a 5% level of significance. Results: twelve cases presented recurrence of convulsions after magnesium sulfate (10%) and all received a repeated dose. In four of them convulsions persisted and they received intravenous diazepam. After diazepam, one patient still had seizures, with unsuccessful administration of phenytoin and therefore barbituric coma was induced (thionembutal). This patient had a CT-scan with evidence of intracerebral hemorrhage. Maternal complications were significantly more frequent in the group with recurrence: coma (16.7% versus 0.95), acidosis (50% versus 2.9%), pulmonary edema (16.7% versus 2.9%), cerebral hemorrhage (16.7% versus 0%) and acute renal failure (16.7% versus 1.9%). Three cases of maternal death occurred in patients with recurrence (25%) versus 2 cases in patients without recurrence (1.9%). Conclusions: rate of recurrence after anticonvulsant therapy with magnesium sulfate is low (10%) but it is associated with increased maternal morbidity and mortality. These cases must be managed in an intensive care unit and submitted to routine CT-scan because cerebral hemorrhage can be the cause of recurrence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(4):191-199
DOI 10.1590/S0100-72032000000400002
Purpose: to determine the frequency of prenatal diagnosis in newborns with gastroschisis operated at the Instituto Materno-Infantil de Pernambuco (IMIP) and to analyze its repercussions on neonatal prognosis. Patients and Methods: a cross-sectional study was carried out, including 31 cases of gastroschisis submitted to surgical correction in our service from 1995 to 1999. Prevalence risk (PR) of neonatal death and its 95% confidence interval were calculated for the presence of prenatal diagnosis and other perinatal and surgical variables. Multiple logistic regression analysis was carried out to determine the adjusted risk of neonatal death. Results: only 10 of 31 cases of gastroschisis (32.3%) had prenatal diagnosis and all were delivered at IMIP. No newborn with prenatal diagnosis was preterm but 43% of those without prenatal diagnosis were premature (p < 0,05). Birth-to-surgery interval was significantly greater in the absence of prenatal diagnosis (7.7 versus 3.8 hours). The type of surgery, need of mechanical ventilation and frequency of postoperative infection were not different between the groups. Neonatal death was more frequent in the group without prenatal diagnosis (67%) than in the group with prenatal diagnosis (20%). The main factors associated with increased risk of neonatal death were gestational age <37 weeks, absence of prenatal diagnosis, delivery in other hospitals, birth-to-surgery interval > 4 hours, staged silo surgery, need of mechanical ventilation and postoperative infection. Conclusions: prenatal diagnosis was infrequent among infants with gastroschisis and neonatal death was extremely high in its absence. It is necessary to achieve greater rates of prenatal diagnosis and to improve perinatal care in order to reduce this increased mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(4):191-199
DOI 10.1590/S0100-72032000000400002
Purpose: to determine the frequency of prenatal diagnosis in newborns with gastroschisis operated at the Instituto Materno-Infantil de Pernambuco (IMIP) and to analyze its repercussions on neonatal prognosis. Patients and Methods: a cross-sectional study was carried out, including 31 cases of gastroschisis submitted to surgical correction in our service from 1995 to 1999. Prevalence risk (PR) of neonatal death and its 95% confidence interval were calculated for the presence of prenatal diagnosis and other perinatal and surgical variables. Multiple logistic regression analysis was carried out to determine the adjusted risk of neonatal death. Results: only 10 of 31 cases of gastroschisis (32.3%) had prenatal diagnosis and all were delivered at IMIP. No newborn with prenatal diagnosis was preterm but 43% of those without prenatal diagnosis were premature (p < 0,05). Birth-to-surgery interval was significantly greater in the absence of prenatal diagnosis (7.7 versus 3.8 hours). The type of surgery, need of mechanical ventilation and frequency of postoperative infection were not different between the groups. Neonatal death was more frequent in the group without prenatal diagnosis (67%) than in the group with prenatal diagnosis (20%). The main factors associated with increased risk of neonatal death were gestational age <37 weeks, absence of prenatal diagnosis, delivery in other hospitals, birth-to-surgery interval > 4 hours, staged silo surgery, need of mechanical ventilation and postoperative infection. Conclusions: prenatal diagnosis was infrequent among infants with gastroschisis and neonatal death was extremely high in its absence. It is necessary to achieve greater rates of prenatal diagnosis and to improve perinatal care in order to reduce this increased mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):253-260
DOI 10.1590/S0100-72031998000500004
Objectives: To determine sensitivity, specificity, positive and negative predictive values of the shake test (Clements) for evaluation of fetal lung maturation in preeclamptic patients. Methods: A prospective study for validation of a diagnostic method was conducted enrolling 163 preeclamptic patients (gestational age between 28-34 weeks) admitted at CAM-IMIP with indication for fetal maturity testing. Preeclampsia diagnosis and classification followed criteria of the National High Blood Pressure Working Group, 1990. Clements' test was performed in three tubes and positive, negative or intermediate results were considered for analysis (related to presence or absence of fetal lung maturity). Accuracy parameters were calculated considering actual incidence of hyaline membrane disease (positive maturity = absent disease) after birth. Hyaline membrane disease was defined by criteria of CLAP, 1978. Statistical analysis was performed using c² test (Epi-Info 6.04b) with a 5% significance level. Results: Intermediate results were considered alternately as positive or negative for analysis. When considered positive, sensitivity was 87.9% and specificity 74.5% with positive and negative predictive values of 8.9.4% and 71.4% respectively - efficiency was 84%. When intermediate results were evaluated as negative, sensitivity decreased to 62% and specificity raised to 89.4% and positive and negative predictive values were 93.5% and 51.2% respectively (efficiency = 70%). False-positive results were rare and usually related to neonatal hypoxia: only 5 (6.5%) of 77 neonates with previous positive Clements had hyaline membrane disease. Nevertheless, false negatives were frequent: almost 40% for negative/intermediate results. Conclusions: Despite its limitations, Clements' test remains a good method for investigation of fetal lung maturation in preeclamptic patients since false positive results are unusual. However sensitivity is low and results have be cautiously analyzed because of elevated rate of false negative results. A good policy is to complement fetal maturity investigation with other tests if a negative result is determined, specially in severe cases when confirmed maturity represents indication for interruption of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):253-260
DOI 10.1590/S0100-72031998000500004
Objectives: To determine sensitivity, specificity, positive and negative predictive values of the shake test (Clements) for evaluation of fetal lung maturation in preeclamptic patients. Methods: A prospective study for validation of a diagnostic method was conducted enrolling 163 preeclamptic patients (gestational age between 28-34 weeks) admitted at CAM-IMIP with indication for fetal maturity testing. Preeclampsia diagnosis and classification followed criteria of the National High Blood Pressure Working Group, 1990. Clements' test was performed in three tubes and positive, negative or intermediate results were considered for analysis (related to presence or absence of fetal lung maturity). Accuracy parameters were calculated considering actual incidence of hyaline membrane disease (positive maturity = absent disease) after birth. Hyaline membrane disease was defined by criteria of CLAP, 1978. Statistical analysis was performed using c² test (Epi-Info 6.04b) with a 5% significance level. Results: Intermediate results were considered alternately as positive or negative for analysis. When considered positive, sensitivity was 87.9% and specificity 74.5% with positive and negative predictive values of 8.9.4% and 71.4% respectively - efficiency was 84%. When intermediate results were evaluated as negative, sensitivity decreased to 62% and specificity raised to 89.4% and positive and negative predictive values were 93.5% and 51.2% respectively (efficiency = 70%). False-positive results were rare and usually related to neonatal hypoxia: only 5 (6.5%) of 77 neonates with previous positive Clements had hyaline membrane disease. Nevertheless, false negatives were frequent: almost 40% for negative/intermediate results. Conclusions: Despite its limitations, Clements' test remains a good method for investigation of fetal lung maturation in preeclamptic patients since false positive results are unusual. However sensitivity is low and results have be cautiously analyzed because of elevated rate of false negative results. A good policy is to complement fetal maturity investigation with other tests if a negative result is determined, specially in severe cases when confirmed maturity represents indication for interruption of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):289-292
DOI 10.1590/S0100-72031998000500009
Pneumoperitoneum, abdominal pain and paralytic ileus in the postoperative period are usually related to perforation of the gastrointestinal tract. The authors present a case of a patient submitted to cesarean section (abruptio placentae) who had a postoperative course of abdominal distention and abdominal pain. Abdominal X-ray showed important dilatation of the colon and small bowel. Pneumoperitoneum was seen on chest X-ray. An exploratory laparotomy was performed because of suspicion of intestinal perforation. The operation showed a marked dilatation of bowel, pneumoperitoneum, and infected hemoperitoneum and subaponeurotic hematoma (Escherichia coli), without any perforation. Postoperative recovery was good and antibiotics were given for 4 days (ceftriaxone + metronidazole). The patient was diseharged from hospital on the 7th day after laparotomy. After review of the literature the authors concluded that this case of pneumoperitoneum was probably related to infection by a gas-producing bacterium in a patient with clinical findings of paralytic ileus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):289-292
DOI 10.1590/S0100-72031998000500009
Pneumoperitoneum, abdominal pain and paralytic ileus in the postoperative period are usually related to perforation of the gastrointestinal tract. The authors present a case of a patient submitted to cesarean section (abruptio placentae) who had a postoperative course of abdominal distention and abdominal pain. Abdominal X-ray showed important dilatation of the colon and small bowel. Pneumoperitoneum was seen on chest X-ray. An exploratory laparotomy was performed because of suspicion of intestinal perforation. The operation showed a marked dilatation of bowel, pneumoperitoneum, and infected hemoperitoneum and subaponeurotic hematoma (Escherichia coli), without any perforation. Postoperative recovery was good and antibiotics were given for 4 days (ceftriaxone + metronidazole). The patient was diseharged from hospital on the 7th day after laparotomy. After review of the literature the authors concluded that this case of pneumoperitoneum was probably related to infection by a gas-producing bacterium in a patient with clinical findings of paralytic ileus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):309-316
DOI 10.1590/S0100-72032003000500002
PURPOSE: to determine the prevalence of domestic physical violence among women who delivered at a tertiary center in the Northeast of Brazil, to study the main risk factors associated with domestic violence, and to determine perinatal outcome. METHODS: a cross-sectional study was conducted, enrolling 420 women who delivered at a tertiary center in Recife (Brazil) with fetuses weighing more than 500 g. They were submitted to interviews with open and closed questions. The prevalence of domestic physical violence was determined. Statistical analysis was performed using c² and Fisher's exact tests at a 5% level of significance. The prevalence ratio was determined as measurement of relative risk of violence. Multiple logistic regression analysis was performed and the adjusted risk was calculated. RESULTS: the prevalence of domestic physical violence was 13.1% (95% CI = 10.1-16.6) and 7.4% (95% CI = 5.2-10.2) before and during pregnancy, respectively. The pattern of violence has changed during pregnancy: stopped in 43.6%, was reduced in 27.3% and increased in 11% of the victims. After multivariate analysis the variables that persisted strongly associated with violence were low female educational level, history of violence in the women´s family, partner's use of alcohol and unemployment. Perinatal outcome was studied and a significantly higher frequency of neonatal death was observed among victims of domestic violence. CONCLUSIONS: a high prevalence of domestic physical violence was observed (about 13%) in women who delivered at a tertiary center in Northeast of Brazil. The main risk factors were low educational level and previous familiar history of violence in the women's family, alcohol use by and unemployment of their partners. Neonatal mortality was increased in victims of violence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):309-316
DOI 10.1590/S0100-72032003000500002
PURPOSE: to determine the prevalence of domestic physical violence among women who delivered at a tertiary center in the Northeast of Brazil, to study the main risk factors associated with domestic violence, and to determine perinatal outcome. METHODS: a cross-sectional study was conducted, enrolling 420 women who delivered at a tertiary center in Recife (Brazil) with fetuses weighing more than 500 g. They were submitted to interviews with open and closed questions. The prevalence of domestic physical violence was determined. Statistical analysis was performed using c² and Fisher's exact tests at a 5% level of significance. The prevalence ratio was determined as measurement of relative risk of violence. Multiple logistic regression analysis was performed and the adjusted risk was calculated. RESULTS: the prevalence of domestic physical violence was 13.1% (95% CI = 10.1-16.6) and 7.4% (95% CI = 5.2-10.2) before and during pregnancy, respectively. The pattern of violence has changed during pregnancy: stopped in 43.6%, was reduced in 27.3% and increased in 11% of the victims. After multivariate analysis the variables that persisted strongly associated with violence were low female educational level, history of violence in the women´s family, partner's use of alcohol and unemployment. Perinatal outcome was studied and a significantly higher frequency of neonatal death was observed among victims of domestic violence. CONCLUSIONS: a high prevalence of domestic physical violence was observed (about 13%) in women who delivered at a tertiary center in Northeast of Brazil. The main risk factors were low educational level and previous familiar history of violence in the women's family, alcohol use by and unemployment of their partners. Neonatal mortality was increased in victims of violence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):342-349
DOI 10.1590/S0100-72031998000600007
Objectives: to determine prognostic factors for vaginal delivery in pregnant women after previous cesarean section admitted to CAM-IMIP in labor.Patients and Methods: a case-control study was performed, analyzing all deliveries of patients with previous cesarean section admitted to CAM-IMIP between January 1991 and December 1994. Patients who had a cesarean section (n=156) were considered cases while patients with a vaginal birth were the controls (n=338). Inclusion criteria were: gestational age > 36 weeks, previous cesarean section at least 1 year before, alive fetus, spontaneous labor and vertex presentation. Patients with high-risk pregnancies, acute fetal distress and a previous vaginal delivery after cesarean section were excluded. Statistical analysis was performed with in Epi-Info 6.0 and Epi-Soft, using c² test, Fisher's exact test and Student's "t" test. Odds ratio and its 95% confidence interval was calculated and multiple logistic regression analysis was performed for the control of confounding factors. Results: overall rate of cesarean section was 31.6%. Maternal factors significantly associated with vaginal delivery were age < 20 years (OR = 2.07, 95% CI = 1.18-3.66) or > 35 years (OR = 0.54, 95% CI = 0.36-0.82), history of vaginal delivery (OR = 1.6, 95% CI = 1.01-2.55) and complications of pregnancy as indication for previous cesarean section (OR = 3.67, 95% CI =1.19-12.02). A significant association with vaginal delivery could not be detected for other variables: interval between previous cesarean section and present delivery, other indications for cesarean section and type of uterine suture. In a multiple logistic regression model the variables that remained associated with vaginal delivery were maternal age and previous vaginal delivery. Conclusions: maternal age below 20 years, previous cesarean section indicated due to gestational complications and previous vaginal delivery were favorably associated with vaginal delivery in patients with prior cesarean section. Risk of repeated cesarean section is increased in pregnant women aged 35 years or above. These factors should be contemplated when obstetrical evaluation of the delivery route is performed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):342-349
DOI 10.1590/S0100-72031998000600007
Objectives: to determine prognostic factors for vaginal delivery in pregnant women after previous cesarean section admitted to CAM-IMIP in labor.Patients and Methods: a case-control study was performed, analyzing all deliveries of patients with previous cesarean section admitted to CAM-IMIP between January 1991 and December 1994. Patients who had a cesarean section (n=156) were considered cases while patients with a vaginal birth were the controls (n=338). Inclusion criteria were: gestational age > 36 weeks, previous cesarean section at least 1 year before, alive fetus, spontaneous labor and vertex presentation. Patients with high-risk pregnancies, acute fetal distress and a previous vaginal delivery after cesarean section were excluded. Statistical analysis was performed with in Epi-Info 6.0 and Epi-Soft, using c² test, Fisher's exact test and Student's "t" test. Odds ratio and its 95% confidence interval was calculated and multiple logistic regression analysis was performed for the control of confounding factors. Results: overall rate of cesarean section was 31.6%. Maternal factors significantly associated with vaginal delivery were age < 20 years (OR = 2.07, 95% CI = 1.18-3.66) or > 35 years (OR = 0.54, 95% CI = 0.36-0.82), history of vaginal delivery (OR = 1.6, 95% CI = 1.01-2.55) and complications of pregnancy as indication for previous cesarean section (OR = 3.67, 95% CI =1.19-12.02). A significant association with vaginal delivery could not be detected for other variables: interval between previous cesarean section and present delivery, other indications for cesarean section and type of uterine suture. In a multiple logistic regression model the variables that remained associated with vaginal delivery were maternal age and previous vaginal delivery. Conclusions: maternal age below 20 years, previous cesarean section indicated due to gestational complications and previous vaginal delivery were favorably associated with vaginal delivery in patients with prior cesarean section. Risk of repeated cesarean section is increased in pregnant women aged 35 years or above. These factors should be contemplated when obstetrical evaluation of the delivery route is performed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):353-357
DOI 10.1590/S0100-72031999000600009
Introduction: meconium peritonitis as result of fetal intestinal perforation has a low incidence (1:30,000 deliveries) and high mortality (50% or more). Prenatal ultrasound findings include fetal ascites and intra-abdominal calcifications. Evidence suggests that prenatal diagnosis can improve postnatal prognosis. Case Report: R.C.M.S., 22 years, II pregnancy O para, presented ultrasound (12/02/98) with diagnosis of fetal ascites. Investigation for hydrops fetalis was performed and immune and nonimmune causes were excluded. Severe fetal ascites persisted on subsequent ultrasound examinations, without calcifications. Vaginal delivery occurred at 36 weeks (01/02/99), with polyhydramnios. Female neonate weighing 2,670 g, with signs of respiratory distress, abdominal distension and petechiae. Abdominal distension worsened progressively, with palpation of a petrous tumor in the right upper quadrant and elimination of white mucus at rectal examination. Radiological findings (01/04/99) were disseminated abdominal calcifications, intestinal dilatation and absence of gas at rectal ampulla. Exploratory laparotomy was indicated with diagnosis of meconium peritonitis. A giant meconium cyst and ileal atresia were observed and lysis of adhesions and ileostomy were performed. Initial postoperative evolution was satisfactory but was subsequently complicated by sepsis and neonatal death occurred (01/09/99). Conclusion: meconium peritonitis should be remembered at differential diagnosis of fetal ascites. In the present case, surgical indication could be anticipated if prenatal diagnosis were established, with improvement of neonatal evolution.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):353-357
DOI 10.1590/S0100-72031999000600009
Introduction: meconium peritonitis as result of fetal intestinal perforation has a low incidence (1:30,000 deliveries) and high mortality (50% or more). Prenatal ultrasound findings include fetal ascites and intra-abdominal calcifications. Evidence suggests that prenatal diagnosis can improve postnatal prognosis. Case Report: R.C.M.S., 22 years, II pregnancy O para, presented ultrasound (12/02/98) with diagnosis of fetal ascites. Investigation for hydrops fetalis was performed and immune and nonimmune causes were excluded. Severe fetal ascites persisted on subsequent ultrasound examinations, without calcifications. Vaginal delivery occurred at 36 weeks (01/02/99), with polyhydramnios. Female neonate weighing 2,670 g, with signs of respiratory distress, abdominal distension and petechiae. Abdominal distension worsened progressively, with palpation of a petrous tumor in the right upper quadrant and elimination of white mucus at rectal examination. Radiological findings (01/04/99) were disseminated abdominal calcifications, intestinal dilatation and absence of gas at rectal ampulla. Exploratory laparotomy was indicated with diagnosis of meconium peritonitis. A giant meconium cyst and ileal atresia were observed and lysis of adhesions and ileostomy were performed. Initial postoperative evolution was satisfactory but was subsequently complicated by sepsis and neonatal death occurred (01/09/99). Conclusion: meconium peritonitis should be remembered at differential diagnosis of fetal ascites. In the present case, surgical indication could be anticipated if prenatal diagnosis were established, with improvement of neonatal evolution.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.