Authors' Reply


We thank Graham et al.[1] for raising this interesting point. Our study collected information on previously identified risk factors for surgical site infection following caesarean section. Much of this literature comes from surveillance studies where detailed information on body temperature would be difficult to collect routinely and as such, rarely evaluated in this setting.

Although the UK National Institute for Health and Clinical Excellence (NICE) guideline on the management of inadvertent perioperative hypothermia in adults does cite some evidence for the association between hypothermia and surgical site infection, this was based on a study of patients undergoing colorectal surgery.[2, 3] Furthermore, pregnant women are specifically excluded from the recommendations on management of hypothermia included in the NICE guideline. The risk factors for adverse events associated with perioperative hypothermia are not common in women undergoing caesarean section (American Society of Anesthesiologists score >2, increased risk of a morbid cardiac event, older age) with most procedures completed in less than an hour.

Normothermia could help to prevent surgical site infection in women having nonurgent caesarean section, alongside interventions aimed at other aspects of care that may contribute to the increased risk of surgical site infection such as skin preparation, surgical technique and postoperative wound dressings.[4] However, as the evidence for its benefit in caesarean section is unclear,[5] we feel that further research should be undertaken to help guide the management of these women.


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  2. References
  • 1
    Graham N, Mahoney C, Dickson MJ. Risk factors for surgical site infection following caesarean section in England. BJOG 2013;120:509.
  • 2
    National Collaborating Centre for Nursing and Supportive Care. The management of inadvertent perioperative hypothermia in adults. NICE. 2008[]. Accessed 6 November 2012.
  • 3
    Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996;334:120915.
  • 4
    National Collaborating Centre for Women's and Children's Health. Surgical site infection—prevention and treatment of surgical site infection. Clinical Guideline. NICE. 2008[]. Accessed 6 November 2012.
  • 5
    Edwards RK, Madani K, Duff P. Is perioperative hypothermia a risk factor for post-Cesarean infection? Infect Dis Obstet Gynecol 2003;11:7580.