Tuesday, 6 Dec 2022

Post-cesarean wound infection: Causes and treatment

An estimated 3–15 percent of woman develop an infection in their cesarean incision wounds.

This article looks at the causes and types of wound infections after a cesarean, risk factors, and treatments.

Causes

Cesarean delivery, which some people call a C-section, is a major surgery. It comes with the same risks, including wound infections, as other types of surgery.

Infections occur when bacteria enter the wound. Staphylococcus aureus, or staph bacteria, are the most common cause of post-cesarean wound infections, causing an estimated 15–20 percent of cases.

Staph bacteria naturally live on people’s hair and skin. When they multiply and enter a wound, they can cause several types of infection.

Staph can cause the following types of post-cesarean wound infection:

  • Impetigo. Impetigo causes shallow, fluid-filled blisters that rupture and leave behind honey-colored crusts. It can be very painful and itchy.
  • Abscesses. Abscesses are sores filled with dead skin and pus that develop under the skin. They may feel warm and painful.
  • Cellulitis. Cellulitis is an infection of the skin and tissues just below it. The symptoms can quickly spread from the incision site outward and is typically painful, red, and warm to the touch.

Wound infections usually arise after 4–7 days. When the symptoms begin within 28 hours, Streptococcus, or strep, bacteria may be the cause.

Strep infections can cause erysipelas. This is a type of cellulitis that also involves the lymph system. Women with erysipelas typically have red, shiny, raised lesions with clear margins.

Other bacteria that can cause infections in cesarean wounds include:

  • Ureaplasma urealyticum
  • Staphylococcus epidermidis
  • Enterococcus faecalis
  • Escherichia coli
  • Proteus mirabilis

A person may mistake a wound infection for other complications that can affect the wound after a cesarean delivery. These include:

  • hematomas, or pockets of blood, that can form around the wound
  • seromas, or pockets of fluid, that can form around the wound
  • wound dehiscence, which occurs when tissues in the wound separate along the incision line

Hematomas and seromas are more common when the incision is stretched or stressed. They affect an estimated 2–5 percent of women after cesarean delivery.

MRSA

MRSA

MRSA one year later

Risk factors

There are many risk factors that can increase a person’s chances of developing post-caesarean wound infections, such as:

  • having a hematoma
  • having bacterial infections in the amniotic fluid, or chorioamnionitis
  • using tobacco during pregnancy
  • having a larger incision size, or an incision over 16.6 centimeters
  • not receiving enough prenatal care
  • having obesity
  • using corticosteroids
  • having diabetes or gestational diabetes
  • having twins
  • having had a previous caesarean delivery
  • having an epidural
  • having a ruptured uterus
  • having had blood transfusions
  • having had a long surgery, or one that took longer than 38 minutes
  • having had emergency surgery

It is possible to reduce the risk of developing wound infections after a cesarean delivery by:

  • managing risk factors such as diabetes, obesity, and tobacco use
  • managing health conditions that weaken a person’s immune system
  • seeking proper medical care both before and after the delivery to reduce the risk of complications
  • taking antibiotics before the surgery, particularly if a person has risk factors for infections

Before starting the surgery, a healthcare practitioner will wash the abdomen to limit the number of bacteria there. They may also trim any pubic hair, as well as wash and disinfect the area, also to limit the amount and type of bacteria.

Some studies suggest that wounds closed with sutures, compared with staples, are less likely to develop infections. However, more research is needed to confirm this.

After a cesarean delivery, the healthcare practitioner should teach a person proper wound care methods to use at home, such as:

  • cleaning wounds and changing their dressings exactly how and how often hospital staff instructed, which is generally daily
  • taking antibiotics as the doctor prescribed and not skipping a dose or stopping the course early
  • avoiding putting any pressure on the wound, such as by wearing loose clothing
  • wearing clean cotton underwear
  • avoiding strenuous activities, including driving, until a doctor says it is safe and the wound has healed
  • avoiding placing anything in the vagina or having sex for a few weeks
  • avoiding lifting anything heavy
  • not allowing other skin to touch the area to reduce bacteria

When to see a doctor

Always talk with a doctor or medical staff about unusual symptoms, especially:

  • pus or drainage from the wound
  • fever
  • increased pain
  • spreading skin redness
  • skin hardness

Outlook

Cesarean deliveries are becoming increasingly common. Around 22.9 million people worldwide had a caesarean delivery in 2012.

Infections delay recovery time, but doctors tend to manage post-cesarean infections with a combination of antibiotics, minor surgery, and proper hygiene and wound care.

Infections can cause serious complications, so a person should consider talking to a doctor if they notice any signs of infection.

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