Post Emergency Cesarean Surgical Site Infections: Analyzing Risk Factors and Impact on Maternal Morbidity

Abstract

Background. Cesarean section (CS) is one of the most performed surgeries in
obstetrics. Post-cesarean surgical site infections (SSI) remain a significant cause of
morbidity and extended hospital stay.
Aims and Objectives: The aim of this study was to determine the incidence rate and
study the clinical profile, risk factors and associated maternal morbidity associated
with surgical site infections in women undergoing caesarean section.
Methodology : We conducted a retrospective cohort study involving women who
underwent Cesarean from July 2024 to December 2024, in the department of
Obstetrics and Gynecology, GMC Jammu. Visual inspection during ward rounds,
reports from laboratory, and postprocedure follow-ups formed the basis of
identifying infections in the patients. Sociodemographic features, laboratory
parameters, comorbid diseases and surgical characteristics were recorded and
statistical analysis done.
Results: The rate of surgical site infection requiring hospitalization was 1.7%
(76/4490). 40.78% of the patients had deep surgical site infections. Mean age of the
study population was 32.46 ± 2.65. In the infection positive group, Host related risk
factors included severe anemia in 55.26% (RR=6.39), previously scarred uterus
which was present in 65.78% of cases (RR=5.28), gestational diabetes (65.78%,
RR=11.32) and hypertension (55.26%, RR=6.08). Intra-partum factors among the
infected group included prolonged leaking for more than 12 hours (47.36%) and
more than five per vaginal (PV) examinations (63.15%). Intraoperative risk factors
included prolonged surgery time (67.10%) and blood loss exceeding 1 liter (36.84%).
Staphylococcus aureus was the most commonly identified pathogen (51.31%) . Postcesarean surgical site infections were associated with significant maternal morbidity.
A prolonged hospital stay (>10 days) was observed in 73.68% of affected patients
with all patients reporting a pain score >4. Fever was present in 55.26% of cases.
Regarding critical care needs, 3.94% of patients required ICU admission, while
13.15% were admitted to a high-dependency unit (HDU) . Additionally, 59.21% of
patients experienced difficulty breastfeeding , indicating a substantial impact on
postpartum recovery.
Conclusion: Post-cesarean surgical site infection (SSI) is a complex clinical
challenge. This study highlights the intricate interplay between various risk factors
associated. By identifying women at higher risk, healthcare providers can adopt
proactive, evidence-based measures and targeted interventions to mitigate postcesarean SSIs and thus decrease its impact on maternal morbidity and enhance
patient safety.