What causes post-cesarean wound infections?

What causes post-cesarean wound infections?


By
Jennifer Huizen
    



Reviewed by Valinda
Riggins Nwadike


Causes | Risk factors | Symptoms | Treatment | Complications | Prevention | When to see a
doctor | Outlook

A
post-cesarean wound infection can occur when bacteria get into the incision
wound. Doctors can treat surgical wound infections with medications and proper
wound care.
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.

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

Symptoms

Women
should check the wound each day for any signs of infection. Many types of
infection do not cause symptoms until 4–7 days after the surgery, when many
women have already returned home from the hospital.
The
symptoms of post-cesarean wound infections vary from mild discomfort to extreme
pain depending on the type and severity of the infection.
Some
of the most common symptoms of post-cesarean section wounds include:
  • fever
  • tenderness
  • redness
  • swelling
    along or near the incision site
  • pain
  • pus
    or other discharge
  • hardening
    of the skin

If
any symptoms of post-cesarean wound infections occur, a person should call
their doctor and seek medical attention.
Treatment

Doctors
treat most post-cesarean wound infections, at least in part, with antibiotics.
The specific type of antibiotic depends on the type of bacteria responsible for
the infection.
Less
severe or superficial infections, such as cellulitis, tend to clear up with a
round or two of antibiotics.
If
fluid is draining from the wound, or if the wound is separating instead of
closing, a doctor may recommend a small surgery to remove abscesses and
infected fluids.
If
the doctor finds dead tissue in the wound, they will peel and scrap off the
layers of dead tissue until they find healthy tissue. During this procedure, a
doctor will also check to make sure that tissues in the area are healthy.
After
the surgery, the doctor will put antiseptic over the area and cover it with
gauze. Some types of gauze have antimicrobial properties that kill bacteria and
prevent further infection.
Hospital
staff will monitor women and their wounds for any signs of infection or any
symptom changes. Women and their loved ones should also continue checking the
site for infection after they return home.
A
doctor will typically check how the wounds are progressing in follow-up
appointments soon after the procedure.
Complications

Staph
infections usually stay on the skin’s surface, though they can also travel to
the bloodstream and affect other organs.
Possible
complications associated with staph infections include:
  • endocarditis,
    an infection of the heart valves
  • osteomyelitis,
    an infection of the bones
  • bacteremia,
    an infection of the bloodstream

Staph
bacteria can also cause toxic epidermal necrolysis, which is a serious
infection that causes large patches of the skin to peel.
In
rare cases, a type of strep bacteria called Streptococcus pyogenes can cause a
severe and potentially fatal infection called necrotizing fasciitis. This
destroys the skin and underlying tissues.
Necrotizing
fasciitis causes fever and extreme pain that increases rapidly over time. Some
women also notice the skin and other tissues become redder or hardened.
Prevention

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, including ways to hold a baby that avoid
placing pressure on the wound.
Other
methods may include:
  • 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
  • avoid
    putting any pressure on the wound, such as by wearing loose clothing and not
    balancing a baby on the area if breastfeeding
  • 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 heavier than a baby
  • 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.
SOURCE: MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.