Infections Complicating Cesarean Delivery

Geeta Sood; Cynthia Argani; Khalil G. Ghanem; Trish M. Perl; Jeanne S. Sheffield

Disclosures

Curr Opin Infect Dis. 2018;31(4):368-376. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Cesarean sections are common surgical procedures performed in a healthy population and are unique because of a relatively high rate of postoperative infection. There have been many important advances in understanding the pathogenesis of infection and evaluation of interventions to prevent post cesarean section infections in the last few years. Our purpose in this review is to analyze these new data, discuss unanswered questions, and propose changes in standard of care.

Recent findings: Wound closure techniques including subcuticular sutures and subcutaneous suturing have been shown to be effective at reducing surgical site infections. Wound dressings including negative pressure dressings likely do not decrease infection rates. The type, timing, and duration of preoperative prophylactic antibiotics, including adjunctive azithromycin for laboring women and multidose antibiotics in obese women, have also yielded mixed results. Our understanding of normal uterine microbiome and the impact of intrapartum antibiotics on the newborn is emerging.

Summary: The pathogenesis of surgical site infections after Cesarean section is complex and multifactorial. Many interventions to reduce infections have been studied with varying degrees of effectiveness. Despite advances in the area, important questions remain unanswered.

Introduction

There are 4 million births annually in the United States, 32% of which are delivered by cesarean section.[1] Worldwide 18.6% of births are by Cesarean section.[2] Cesarean sections, while sometimes life-saving, are associated with complications such as hemorrhage and infection. Infection rates vary widely by patient risk factors and by facility.[3,4] Post Cesarean surgical site infections (SSIs) can range from superficial wound infections to endometritis and intrabdominal abscesses and sepsis. There have been several important advances in our understanding of risk factors and prevention strategies for Cesarean section SSIs over the last few years. This paper outlines these advances and explores areas where further study is needed.

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