Incidence and risk factors for caesarean wound infection in Lagos Nigeria

Abstract

BackgroundPost caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors.FindingsProspective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0.Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3%) of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3%) than in the subjects without wound infection (33.9%) p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02), prolonged operation time (p = 0.001), anaemia (p = 0.031) and multiple vaginal examinations during labour (0.021) among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45), prolonged operation time (OR = 2.87) and body max index > 25 (2.34) retained their association with post caesarean wound infection.ConclusionEffort should be geared towards the prevention of prolonged rupture of fetal membrane and the reduction of prolonged operation time by the use of potent antibiotics, early intervention and use of good surgical technique. In obese women improved surgical technique and use of non absorbable sutures may suffice.

Risk factors for post caesarean surgical site infection at a tertiary care center in Eastern Nepal

“…All analysis was carried out using the statistical software SPSS version 16 3,4,6 One of the patient related factors is young maternal age as most of the infections (92%) occurred in women less than thirty years of age, this is in accordance with other studies. 7,8 Hypertensive disorders in pregnancy which is linked with chronic alteration in peripheral blood supply have been found to a risk factor for SSI.9, 10 In this study 27.7% of patients with SSI suffered from this condition. Both obesity and malnutrition have been associated with increased risk of SSI.…”

“…Both obesity and malnutrition have been associated with increased risk of SSI. 7,8 The association of obesity with SSI could be due to relative avascularity of adipose tissue and hence poor healing, difficulty in handling of tissues and hence more chance of micro-trauma and also failure in obliteration of dead spaces. Likewise malnutrition can lead to SSI due to poor healing of tissues and decreased immunity.…”

Epidemiology, Risk Factors and Outcome of Complications in Obstetric and Gynecological Surgeries—A Tertiary Center Experience from Western India

“…When elective surgeries are undertaken, care should be taken to correct these factors before surgery. Oliver Ezechi et al [4] found factors like BMI > 25 kg/m 2 , anemia and prolonged operative time associated with increased incidence of post operative wound infection. All the gynecological surgeries were elective and so intra operative complications were significantly less in gynecological surgeries as compared to obstetric surgeries where a lot of surgeries were taken on emergency basis.…”

A randomised controlled trial on suture materials for skin closure at caesarean section: Do wound infection rates differ?

“…6,[9][10][11][12][13] This variation probably results from several factors in the various studies. [9][10][11][12][13] Firstly, studies with broad exclusion criteria have lower wound complication rates than studies with stringent exclusion criteria. The wound complication rate in our study was 7%, with the only exclusion criterion being declining to participate.…”