What causes post-cesarean wound infections?
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.
Common symptoms of post-caesarean wound infections can include tenderness, redness, fever, and pain.
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 one year later
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
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:
- swelling along or near the incision site
- 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.
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.
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.
A person should seek proper medical care before and after the delivery to reduce the risk of developing wound infections.
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
- increased pain
- spreading skin redness
- skin hardness
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.