The caesarean operation for childbirth is one of the oldest surgical procedures known – and yet still carries a significantly high risk of leading to infection, researchers warn today.
Almost ten per cent of women who undergo a caesarean section develop an infection, with overweight or obese women at highest risk, researchers say.
Research from the Health Protection Agency (HPA) found that out of 4,107 women who had the operation in 2009 in 14 acute hospitals in England, 394 infections were discovered at the site of surgery.
The rate of infection is higher than would be expected for a relatively “clean” operation, the researchers warn.
Using similar methods to identify infection risk, the rate of infection following a hysterectomy is 6.6 per cent and for operations in the large bowel it is 14.7 per cent.
The study, which is published in the British Journal of Obstetrics & Gynaecology, said that 88 per cent of the infections were minor.
<!Of the 394 women who developed an infection, 348 (88.3 per cent) had superficial incisional infections, which clear up after a few days and may require antibiotic treatment; 19 (4.8 per cent) had deep incisional surgical infections affecting deeper tissues under the skin; 27 (6.9 per cent) had organ/space infections, 25 of which were classed as endometritis; and 23 (5.8 per cent) had to be readmitted to hospital for treatment of their infection.>
A number of factors were associated with the development of an infection, the strongest of which was weight, the researchers say.
Those who were overweight were 1.6 times more likely to develop an infection, obese women were 2.4 times more likely and those with a BMI over 35, 3.7 times more likely.
The research also found that women under 20 years of age, compared with those aged 25 to 30, were 1.9 times more likely to develop an infection.
Dr Catherine Wloch, Department of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, and lead author of the paper said: “This study has identified high rates of surgical infection following a caesarean with one in ten women developing an infection. Whilst our study didn’t measure this, these infections are likely to have an impact on a woman’s experience and quality of life.
"Prevention of these infections should be a clinical and public health priority.”
Dr Elizabeth Sheridan, Head of Healthcare Associated Infections at the HPA, said: “Reducing rates of surgical site infections following a caesarean should be made a priority. Given that one in four women deliver their baby by caesarean section, these infections represent a substantial burden.
“Women choosing to have caesarean section for non-medical reasons should be aware of the risk of infection, particularly if they are overweight.
“As levels of obesity are rising, optimising surgical techniques and identifying the most appropriate dosing of antibiotics could provide a means for reducing wound infections in obese women.”
Gail Johnson, of the Royal College of Midwives, said: “This further supports the need to ensure that any caesarean section is performed only where clinically indicated, following full and detailed discussion with the woman, the midwife and the obstetrician in accordance with NICE guidelines."
British Journal of Obstetrics & Gynaecology August 1 2012
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