TITLE:
Postpartum Infection in Morbidly Obese Women after Caesarean Section: Does Early Prophylactic Oral Antibiotic Use Make a Difference?
AUTHORS:
Hannah Yeeles, Sarah Trinick, Charmaine Childs, Hora Soltani, Tom Farrell
KEYWORDS:
Wound, Surgical Site Infection, Morbidly Obese, Caesarean Section
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.9,
June
25,
2014
ABSTRACT: The rising prevalence of
morbid obesity particularly in women coupled with a higher likelihood of having
a caesarean section (C-section) birth and an increased risk of surgical site
infection (SSI) places wound management among priority areas in maternity care.
There is ambiguity about the efficacy of routine preventative care pathways
particularly in morbid obese women with regards to SSI after caesarean section.
A pilot study was therefore undertaken to explore the number of women with a
C-section infection in a cohort of morbidly obese women during six weeks
postpartum against a protocol of standard care of early antibiotic prophylaxis
and skin closure practice. A short questionnaire was sent to 59 women with an
early pregnancy BMI ≥ 40 who gave birthviaC-section in a large maternity unit in
Sheffield, UK. Data were collated from 39 women with 20 (51%) developing a
post-operative wound infection within 6 weeks postpartum. Infections were
higher in the women who had emergency C-section births (14/24, 60%). There was
no significant difference in wound infection risk with respect to wound closure
material (Chi-square = 0.298, p-value = 0.86) or the use of oral prophylactic
antibiotic after birth (Chi-square = 0.2053, p-value = 0.650). Although all the
women received routine intravenous (IV) antibiotics before C-section, only
26/39 received the 5-day oral antibiotic prophylaxis after birth. Six of 13 women
who did not receive postpartum oral antibiotics (46%) developed a SSI. In
summary, over half of morbidly obese women who delivered by C-section developed
a wound infection, despite receiving prophylactic antibiotics. We acknowledge
the limitations of these results froma
small-sample retrospective observational study. However,this may indicate that post operative
antibiotic prophylaxis confers no additional benefit in this group of patients
and thus requires further investigation.