Post-Cesarean Wound Infection: How Did This Happen?

Some women are more likely than others to get a post-cesarean wound infection. Risk factors can include:

• obesity
• diabetes or an immunosuppressive disorder (like HIV)
• chorioamnionitis (infection of the amniotic fluid and fetal membrane) during labor
• taking long-term steroids (by mouth or intravenously)
• poor prenatal care (few visits to a doctor)
• previous cesarean deliveries
• lack of cautionary antibiotics or pre-incision antimicrobial care
• a long labor or surgery
• excessive blood loss during labor, delivery, or surgery

According to a 2012 study published in the South African Medical Journal, women who receive nylon sutures after a cesarean delivery are also more likely to develop an infection. Staple sutures can also be problematic. Sutures made from polyglycolide (PGA) are preferable because they are both absorbable and biodegradable.

If you’ve had a cesarean delivery, it’s important to monitor the appearance of your wound and follow your doctor’s postoperative instructions closely. If you’re unable to see the wound, have a loved one check the wound every other day to watch for warning signs of a wound infection. Having a cesarean delivery can also put you at risk for other problems, such as blood clots.

Call your doctor for advice or seek medical care if you have any of these symptoms after your release from the hospital:

• severe abdominal pain
• redness at the incision site
• swelling of the incision site
• pus discharge from the incision site
• pain at the incision site that doesn’t go away or gets worse
• fever higher than 100.4ºF (38ºC)
• painful urination
• foul-smelling vaginal discharge
• bleeding that soaks a feminine pad within an hour
• bleeding that contains large clots
• leg pain or swelling

Some post-cesarean wound infections are taken care of prior to a patient being discharged from the hospital. However, many infections don’t appear until after you leave the hospital. In fact, many post-cesarean wound infections usually appear within the first couple of weeks after delivery. For this reason, most of these infections are diagnosed at follow-up visits.

Wound infections are diagnosed by:

• wound appearance
• healing progress
• presence of common infection symptoms
• presence of certain bacteria

Your doctor may have to open the wound to make a diagnosis and provide you with proper treatment. If pus is draining from the incision, the doctor may use a needle to remove pus from the wound. The fluid may be sent to a lab to identify any bacteria that are present.

A post-cesarean wound infection is categorized as either wound cellulitis or a wound (abdominal) abscess. These wound infections may also spread and cause problems with organs, the skin, the blood, and local tissue.

Cellulitis

Cellulitis of the wound is typically the result of either staphylococcal or streptococcal bacteria. These strains are part of the normal bacteria found on the skin.

With cellulitis, infected tissue under the skin becomes inflamed. Redness and swelling spread quickly from the surgical incision outward to nearby skin. The infected skin is usually warm and tender to the touch. In general, pus isn’t present in the incision itself.

Wound (abdominal) abscess

A wound (abdominal) abscess is caused by the same bacteria as wound cellulitis and other bacteria. Infection at the site of the surgical incision leads to redness, tenderness, and swelling along the edges of the incision. Pus collects in a tissue cavity caused by the bacterial infection. Most wound abscesses also ooze pus from the incision.

Abscesses can form at the uterine incision, scar tissue, ovaries, and other tissue or nearby organs when an infection is present after surgery.

Some bacteria that cause a wound abscess can also cause endometritis. This is a post-cesarean irritation of the uterine lining that can cause:

• pain
• abnormal bleeding
• discharge
• swelling
• fever
• malaise

Other common infections after a C-section aren’t always present in women who have an incision site infection. These include thrush and urinary tract or bladder infections:

Thrush

Thrush is caused by the fungus Candida, which is normally present in the human body. This fungus can cause an infection in people taking steroids or antibiotics and in people with weakened immune systems. The fungus can cause a vaginal yeast infection or fragile red and white sores in the mouth. Medication isn’t always needed, but an antifungal drug or mouthwash may help you fight the infection. Eat yogurt and other probiotics to prevent the overgrowth of yeast, especially if you have been on antibiotics.

Urinary tract and bladder infections

Catheters used during your hospital stay can cause urinary tract and bladder infections. These infections are usually the result of E. coli bacteria and are treatable with an antibiotic. They can cause a burning feeling during urination, a frequent need to urinate, and a fever.

If you have wound cellulitis, antibiotics should clear up the infection. Antibiotics specifically target staphylococcal and streptococcal bacteria. In the hospital, wound infections are usually treated with intravenous antibiotics. If you’re being treated as an outpatient, you will be given or prescribed antibiotics to take at home.

Wound abscesses are also treated with antibiotics and require special care. Your doctor will open the incision throughout the infected area, and then drain the pus. After the area is carefully washed, your doctor will prevent pus accumulation by putting an antiseptic with gauze on it. The wound will need to be regularly checked to ensure proper healing.

After several days of antibiotic treatment and irrigation, your doctor will check the incision again. At this point, the wound may be closed again or allowed to heal on its own.

Some surgical site infections are out of your control. If you’ve had a C-section, however, you can take certain steps to reduce the chances of getting an infection. If you’re thinking about an elective C-section, you can take measures to prevent complications.

If you’ve already had this type of surgery, here are some measures you can take:

• Follow the wound care instructions and postoperative medication directions given by your doctor or nurse. If you have questions, don’t hesitate to call your doctor.
• If you have been given antibiotics to treat or prevent an infection, don’t skip doses or stop using them until you have finished the entire course of treatment.
• Clean your wound and change the wound dressings regularly.
• Don’t wear tight clothing or apply body lotions over the wound.
• Ask for advice on holding and feeding the baby to avoid uncomfortable pressure on your wound, particularly if you plan to breastfeed.
• Try to avoid allowing skin folds to cover and touch the incision area.
• Take your temperature with an oral thermometer if you feel feverish. Seek medical care or call your doctor if you experience a fever over 100ºF (37.7ºC).
• Seek medical care for incision sites that contain pus, swell, become more painful, or show redness on the skin that spreads from the incision site.

Women with vaginal deliveries are less likely to get postpartum infections. In some cases, however, vaginal birth after C-section (VBAC) is dangerous because of other risks to the mother and baby. Discuss your personal risk factors with your doctor.

If you haven’t had a C-section, here are some steps you can take:

• Maintain a healthy weight. If you aren’t yet pregnant, exercise and follow a healthy diet to avoid pregnancy with an obese body mass index (BMI).
• Opt for a vaginal, spontaneous labor and delivery if possible. Women with vaginal deliveries are less likely to get postpartum infections. (This is the case even in women who’ve had a C-section, but VBAC is dangerous in some cases. It should be discussed with a doctor.)
• Treat preexisting conditions that cause your immune system to be compromised. If you have an infection or illness, try to have it treated before pregnancy or before your due date if it’s safe for you and the baby to do so.

You should also opt for the safest method of wound closure. If your doctor plans to use staples, ask if an alternate method is available (such as PGA sutures). Ask for pre-incision antibiotics and thorough wound care instructions from those treating you at the hospital. Also, ask to be checked for signs of infection before you go home from the hospital.

In some cases, a wound infection can cause serious complications. Examples include:

• necrotizing fasciitis, which is a bacterial infection that destroys healthy tissue
• ruptured fascia or dehiscence of the wound, which is an opening of the skin and tissue layers that were sutured after the surgery
• evisceration, which is an opening of the wound with the bowel coming through the incision

If you develop any of these problems, they’ll need surgical repair. This can also result in a much longer recovery time. In rare cases, complications may be fatal.

If you’re treated early, you can recover from a post-cesarean infection with few long-term consequences. According to the Mayo Clinic, normal incision healing takes four to six weeks. However, if a wound infection is detected before you’re discharged from the hospital, your hospital stay could be at least a few days longer. (This will also increase your hospitalization costs.)

If you’ve already been sent home by the time your post-cesarean wound infection occurs, you may need to be readmitted to receive intravenous drugs or further surgery. Some of these infections can be treated on an outpatient basis with extra doctor visits and antibiotics.