Surgical infections after major operations are common and are rarely attributable to identifiable lapses of surgical or nursing technique (Medical Litigation News Volume 2, Issue 9).
Pelvic and wound infections are particularly common after Cesarean Section[1], [2], [3]. Routine prophylactic antibiotics have proved disappointing in reducing the infection rate[2], [4],[5] and are still being evaluated. They are presently recommended only for specific situations[2], [3], [6] such as Prolonged Rupture of Membranes.
PRACTICE POINT Potentially serious infection is common after Cesarean Section and is not presumptive evidence of substandard care |
Neglect of symptoms and signs of Post-Cesarean infection may nevertheless be actionable The range of severity is such, however, that it is often difficult to demonstrate additional morbidity and hospitalisation after delay in the administration of appropriate antibiotics.
PRACTICE POINT When nurses report mild fever or somewhat offensive wound/vaginal discharge, look for
1. Adequate medical re-examination |
Inappropriate choice of antibiotics after Cesarean Section is commoner for diagnosed wound infections than for sepsis of the uterus (Endomyometritis). The germs Causing either type generally require a broader spectrum of antibacterial agents than in other clinical situations[7], [8], [9]. Standard, usually effective, combinations of antibiotics for the immediate postpartum period have been established in recent years.
PRACTICE POINT Social and economic pressures for early discharge encourage substandard detection and treatment |
Under pressure, obstetricians may be insufficiently vigilant to the early symptoms and signs of serious infection. Premature hospital discharge and the subsequent treatment choices of less specialised physicians and surgeons sometimes result in unnecessarily serious, prolonged and permanent morbidity.
Postpartum hemorrhage that fails to respond to other measures occasionally requires emergency peripartum hysterectomy.
The emergency hysterectomy rate following cesarean section approaches 1% in tertiary care centres, nearly a hundred times as common as following vaginal delivery10.
The commonest cause in multigravidae is abnormal attachment of the placenta, usually a result of previous cesarean section11.
In primigravidae, uterine atony is the commonest cause.
Uterine rupture, particularly following Vaginal Birth After Cesarean Section (VBAC), and laceration into major blood-vessels during cesarean are minority causes.
Emergency peripartum hysterectomy is complicated by bladder injury in about 8% of cases, and injury to the ureter in 2.5%12.
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