Post-Cesarean Wound Infection Health Article

What Do I Have?

A post-cesarean wound infection is a bacterial infection in the surgical incision following an abdominal (cesarean or C-section) delivery. This complication develops in approximately 3 to 5% of women who have a cesarean delivery. Women who develop a post-cesarean wound infection typically experience a moderately high fever (101 to 103° F) and lower abdominal pain.

Who's at Highest Risk?

Some patients are more likely than others to develop a post-cesarean wound infection. High-risk patients include those who:

• are obese;
• have diabetes or an immunosuppressive disorder (HIV infection);
• have chorioamnionitis (infection of the amniotic fluid and fetal membrane) during labor; or
• are taking steroids (by mouth or intravenously).

A post-cesarean wound infection may take one of two forms, wound cellulitis or abscess:

• Wound cellulitis is typically caused by staphylococcal and streptococcal organisms, which are part of the normal bacterial population of the skin. Infected tissue under the skin becomes inflamed, and intense redness and swelling spread rapidly from the surgical incision outward to the adjacent skin. The infected skin is usually warm and tender to the touch. In general, pus is not present within the incision itself.
• A wound abscess is caused by the same bacteria and by multiple other bacteria that cause post-cesarean endometritis. (For more information, go to Infections in Pregnancy: Postpartum Endometritis.) Infection at the site of the surgical incision leads to redness, tenderness, and edema (swelling) along the margin of the incision, accompanied by drainage of pus from the incision.

What Are the Consequences of This Infection?

At minimum, a post-cesarean wound infection prolongs your hospital stay, usually by two days, and increases your hospitalization costs. In some cases, a wound infection can lead to severe complications, such as necrotizing fasciitis (for more information, go to Infections in Pregnancy: Necrotizing Fasciitis), rupturing of the fascia (the strength layer closed during surgery), or actual evisceration (opening of the wound, with the bowel protruding through the incision). Women who develop these complications must undergo at least one additional major operation and require a much longer time to recover. In rare instances, such complications have been fatal.

How Is a Wound Infection Diagnosed?

Wound infections can usually be diagnosed by the physical findings just described. To confirm whether you have an actual wound abscess as opposed to cellulitis, your doctor may have to open the wound with a clamp or cotton swab, or use a needle to remove pus from the wound. If pus is draining from the incision, the infected fluid may be sent to the laboratory, where the bacteria is cultured and identified.

How Should a Wound Infection Be Treated?

If you have wound cellulitis, antibiotics should clear up the infection. The drugs used specifically target staphylococcal and streptococcal bacteria, usually through intravenous cefazolin (Ancef) and nafcillin (Unipen). Examples of oral antibiotics include cephalexin (Keflex), dicloxacillin (Dycill), and amoxicillin-clavulanate (Augmentin).

If you have a wound abscess, you are treated with antibiotics. The wound requires special attention, as follows:

1. The incision is opened throughout the infected area, and the pus is drained.
2. The incision is washed with saline or an antiseptic solution and packed with sterile gauze to prevent pus from accumulating again.
3. The incision is inspected carefully to be certain that the fascia (the fibrous layer that covers the abdominal muscles) has not been disrupted and that the bowel is not rupturing into the incision.

After several days of antibiotic treatment and irrigation, the incision is re-examined to determine whether it can be closed again or if it must be left open and allowed to heal on its own.

Go to Labor & Delivery: Infection After Cesearean Section

For more information about other infections after delivery, go to Infections in Pregnancy: Postpartum Endometritis and Infections in Pregnancy: Mastitis.