Gadeer Roaa, Baatiah Nada Y, Alageel Nourah, Khaled Mohammed
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Jeddah, SAU.
Clinical Nutrition, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2020 Dec 19;12(12):e12164. doi: 10.7759/cureus.12164.
Introduction Cesarean section (C/S) is considered one of the most commonly performed procedures among women. The maternal morbidity due to infection post-C/S reaches eight-fold higher than that of vaginal delivery. Our aim is to identify the incidence and risk factors of surgical site infection (SSI) among patients at King Abdul Aziz Medical City (KAMC), Jeddah, Saudi Arabia, in order to develop a strong strategy to reduce its occurrence. Methods This retrospective cohort study was conducted at KAMC, Jeddah. The study included a total of 387 women who underwent cesarean sections from January 2014 to December 2014. The data were collected consecutively by reviewing medical records of pregnant patients who underwent elective or emergency C/S. The risk factors studied included age, presence of underlying diseases, BMI, hemoglobin level, prophylactic antibiotics, pre-labor rupture of membrane, duration of induction of labor, type of C/S, type of uterine incision, duration of operation, type of anesthesia, estimated blood loss, type of organism, and the duration of hospital stay postoperatively. Results The incidence rate of wound infections (WI) was 3.4% (13/387). The mean age score was 31.1±5.6 years, and the mean score of BMI was 32.7±6.2, where the majority were obese (255, 65.9%). More than half of the participants (205, 53.0%) had elective C/S, with mean hospitalization duration 2.5±1.3 days, and operation duration mean score 59.5±22.0 minutes. The majority (378, 97.7%) received antibiotics before the operation, where cefazolin was the main antibiotic (376, 97.2%). Only 38 (10%) cases had intra-operative complications, where the main complication was postpartum hemorrhage (18, 44.0%). The majority of WI were superficial (11 cases), the main organism was in four (36.4%) cases, followed by in three (27.3%) cases. There was a significant association between WI post-C/S and BMI, type of uterine incision, and induction of labor (P=006, P=0.003, respectively). Conclusions This study showed that WI post-C/S is associated with high BMI, prolonged induction of labor, and Pfannenstiel incision. Reducing the rate of SSI will help to reduce its morbidity by identifying the risk factors pre-pregnancy and encouraging the implementation of preconception counseling clinics and antenatal classes to educate and increase awareness among patients.
引言 剖宫产被认为是女性中最常施行的手术之一。剖宫产术后因感染导致的孕产妇发病率比阴道分娩高八倍。我们的目的是确定沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城（KAMC）患者手术部位感染（SSI）的发生率和危险因素，以便制定一项强有力的策略来减少其发生。方法 这项回顾性队列研究在吉达的KAMC进行。该研究共纳入了2014年1月至2014年12月期间接受剖宫产的387名女性。通过查阅接受择期或急诊剖宫产的孕妇的病历连续收集数据。研究的危险因素包括年龄、基础疾病的存在、体重指数（BMI）、血红蛋白水平、预防性抗生素、临产前胎膜破裂情况、引产持续时间、剖宫产类型、子宫切口类型、手术持续时间、麻醉类型、估计失血量、感染微生物类型以及术后住院时间。结果 伤口感染（WI）发生率为３.４％（13/387）。平均年龄得分是31.1±5.6岁，BMI平均得分是32.7±6.2，其中大多数为肥胖者（255例，65.9％）。超过一半的参与者（205例，53.0％）接受择期剖宫产，平均住院时间为2.5±1.3天，手术持续时间平均得分为59.5±22.0分钟。大多数（378例，97.7％）在手术前接受了抗生素治疗，其中头孢唑林是主要抗生素（376例，97.2％）。只有38例（10％）病例有术中并发症，主要并发症是产后出血（18例，44.0％）。大多数WI为表浅性（11例），主要感染微生物在4例（36.4％）病例中为[此处原文缺失微生物名称]，其次在3例（27.3％）病例中为[此处原文缺失微生物名称]。剖宫产术后WI与BMI、子宫切口类型和引产之间存在显著关联（P分别为0.006、0.003）。结论 本研究表明，剖宫产术后WI与高BMI、引产时间延长和耻骨联合上横切口有关。通过在孕前识别危险因素并鼓励开设孕前咨询诊所和产前课程以对患者进行教育并提高其认识，降低SSI发生率将有助于降低其发病率。
