Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

Abstract

Background Mothers giving birth by non-elective cesarean section have considerably higher risk of developing postoperative infection, than mothers giving birth by elective cesarean section. Meta-analyses have shown that the risk of infection is reduced when administering antibiotics at least 30 min prior to skin incision rather than after cord clamping. If given prior to incision, antibiotics are present in the neonatal bloodstream for up to 24 h after delivery, with early exposure to antibiotics potentially disturbing development of the gut microbiome. We aimed to retrospectively assess the prevalence of postoperative infection after non-elective cesarean section at a single labor ward administering antibiotics after cord clamping, additionally investigating risk factors for developing postoperative infections. Methods In this retrospective cohort study, we included a total of 2,725 women giving birth by non-elective cesarean section in 2010–2017 with a review of records for prenatal risk factors, labor management, and perinatal outcomes. The primary outcomes were a main composite infection of development of either endometritis, surgical-site infection, or sepsis in conjunction with a relevant antibiotic prescription. Secondary outcomes included infection of unknown focus, mastitis, urinary tract infection, and pneumonia. Results A total of 88 patients developed a main composite infection (3.2%). These infections subdivide into endometritis (n = 37/2725, 1.4%), surgical-site infection (n = 35/2725, 1.3%) and sepsis (n = 15/2725, 0.6%). We found a high body mass index (aOR = 3.38, 95%CI 1.93–5.92) and intrapartum fever (aOR = 2.26, 95%CI 1.22–4.59) to be independent risk-factors for developing postoperative infection after non-elective cesarean section. Furthermore, we found delivery by a more expedient emergency grade 2 cesarean section (aOR = 0.61 95%CI 0.37–0.998) compared to grade 3 to be a protective factor for developing postoperative infection after non-elective cesarean section. Conclusion In a labor ward administering antibiotics after cord clamping at non-elective cesarean births, we find a low prevalence of main composite infections when compared to estimates from meta-analyses on the topic. We conclude that administration of prophylactic antibiotics after cord clamping appears to result in acceptable rates of postoperative infection and avoids transplacental-transmission of antibiotics to the infant.

The associations of intra-operative risk factors on Surgical Site Infections: a retrospective cohort study in a Norwegian University Hospital

“…However, in a previous stepped wedge cluster randomized trial, the use of the WHO SSC improved the timeliness of antibiotic provision, and reduced the odds of wound ruptures and infections post operatively (39). The other identi ed perioperative SSIs risk factors i.e., surgical access, procedures, type of anaesthesia, and comorbidities are well-known and consistent with previous studies (10,13,15,(40)(41)(42)(43)(44)(45). The signi cance of these factors suggests that risk assessments and prevention strategies should be personalized, re ecting the complex and multifactorial nature of surgical risks (13).…”

A comprehensive study on the risk factors and pathogen analysis of postoperative wound infections following caesarean section procedures

“…Originally intended for situations where vaginal deliveries were not medically feasible or posed considerable risks, the procedure has now gained acceptance for a variety of reasons, including maternal request and perceived medical advantages. This trend, however, magnifies the clinical relevance of the complications associated with C‐section 20 . Among these complications, postoperative infections are particularly disconcerting.…”

“…This trend, however, magnifies the clinical relevance of the complications associated with C‐section. 20 Among these complications, postoperative infections are particularly disconcerting. Such infections not only extend the duration of hospital stays but also necessitate additional medical interventions, thereby increasing the overall healthcare costs.…”

Pneumonia Deterioration Occurring After C-section in a Preeclamptic Patient: A Case Report

“…Patients who have had a C-section are at an increased risk of developing pneumonia due to several factors [ 14 , 15 ]. The surgical incision can cause decreased lung function, making it harder for patients to clear secretions and increasing the risk of respiratory infections.…”