Verma Aruna, Shrivastava Neelu, Sharma Garima, Sharma Aditya
Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut, IND.
Preventive Medicine, Government Medical College, Badaun, IND.
Cureus. 2023 Mar 28;15(3):e36836. doi: 10.7759/cureus.36836. eCollection 2023 Mar.
Surgical site infection (SSI) is one of the most common complications after cesarean and causes much burden on the mother as well as the health care system. SSIs are defined as infections of a surgical site up to 30 days after surgery. Ultrasonography of the surgical site may be a helpful tool to detect its complication. With this background, the following study was planned to evaluate the clinical significance of sonographically detected fluid collections and post-operative maternal morbidity following cesarean section (CS) and identify risk factors associated with their formation.
This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut. A total of 1000 women, who had undergone CS were included. Sonographic examination of the cesarean site was done on the 3 or 4 postoperative day to look for any fluid collection in the parities or pelvis. All cases were followed on the 8 postoperative day and finally on the 30 postoperative day to look for any SSIs i.e. surgical wound problems like wound infection, induration, and discharge from a surgical wound, or even wound dehiscence and postoperative morbidity. Results: Out of the total cases (1000), abdominal wound fluid collection was noted in 490 (49%) women after CS. Thirty-two patients were lost to follow-up, so 458 patients were followed, of which collection was septated or loculated in 62 (13.6%) and diffused in 396 (86.5%). Out of 62 loculated and 396 diffused cases, 21 (33.87%) and 20 (5.05%) cases reported surgical site abdominal wound infection and needed resuturing, respectively and it was found to be highly significant (p<0.001).
Post-operative fluid collections are common after CS. But it is the pattern of the fluid collection that determines post-operative wound infection and morbidity. Thus ultrasound of the cesarean site may be an important tool to detect surgical site wound complications earlier and to decrease postoperative morbidity.
手术部位感染（SSI）是剖宫产术后最常见的并发症之一，给母亲以及医疗保健系统带来了沉重负担。SSI被定义为术后30天内手术部位的感染。手术部位的超声检查可能是检测其并发症的有用工具。在此背景下，计划进行以下研究，以评估剖宫产术后超声检测到的液体积聚的临床意义以及产妇术后发病率，并确定与其形成相关的危险因素。
这项前瞻性观察研究在密拉特市拉拉·拉杰帕特·莱伊纪念医学院妇产科进行。共纳入1000例接受剖宫产的妇女。在术后第3或第4天对剖宫产部位进行超声检查，以寻找子宫旁或盆腔内的任何液体积聚。所有病例在术后第8天进行随访，最后在术后第30天进行随访，以寻找任何SSI，即手术伤口问题，如伤口感染、硬结、手术伤口渗液，甚至伤口裂开和术后发病率。结果：在全部病例（1000例）中，490例（49%）剖宫产术后妇女出现腹部伤口液体积聚。32例患者失访，因此对458例患者进行了随访，其中62例（13.6%）液体积聚为分隔状或有分隔，396例（86.5%）为弥漫性。在62例有分隔和396例弥漫性病例中，分别有21例（33.87%）和20例（5.05%）报告手术部位腹部伤口感染且需要再次缝合，发现差异具有高度显著性（p<0.001）。
剖宫产术后液体积聚很常见。但液体积聚的模式决定了术后伤口感染和发病率。因此，剖宫产部位的超声检查可能是早期检测手术部位伤口并发症并降低术后发病率的重要工具。
