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Surgical glove perforation in caesarean section and its association with surgical site infections: a prospective

Volkan Özgür Akbulut¹, Dinçer Sümer², Aziz Kından²

¹Ankara Etlik City Hospital, Department of Perinatology, Ankara, Turkey. akbulutvolkan@yahoo.com.

BMC Pregnancy and Childbirth

|August 12, 2025

Abstract

Objective:

Infectious complications at the surgical site complicates 1-4% of cesarean deliveries. Strict aseptic technique, hand hygiene and the use of sterile surgical gloves are essential to reduce the risk of surgical site contamination. Glove perforations are observed in almost 30% of all procedures and represent an underestimated potential risk factor for postoperative infections. The aim of this prospective study was to investigate glove perforation rates in cesarean deliveries and to analyze the impact of unrecognized glove perforations during surgery on surgical site infection rates after cesarean delivery.

Method:

Surgical gloves from cesarean section were collected prospectively. All gloves were inspected for perforation holes. Cases in which surgical gloves had visible (macro) perforations were excluded from the study. Remaining gloves were examined using a water-fill test. Gloves with a positive water filling test were defined as the study group and negative gloves as the control group. Superficial Surgical Site Infections (SSI) were analyzed for the groups.

Results:

A total of 1,779 pairs of used surgical gloves were collected and examined for perforations across 593 cesarean operations. Macro perforation were observed in 56 (9.4%) operations. The remaining 1,611 pairs of gloves underwent water-fill testing. Of these, 505 operations had completely intact gloves, while in 32 (5.4%) cases, micro-perforations were identified. SSI occurred in 18 women (3.3%): 7 in the perforation group (21.8%) and 11 in the control group (2.2%) (p < 0.001). In multivariable logistic regression analysis, glove micro-perforation was found to be a significant independent predictor of SSI (adjusted odds ratio: 12.705; 95% CI: 4.244-38.039; p < 0.001), even after adjusting for potential confounders including diabetes, obesity, emergency cesarean, operative duration, and intraoperative blood loss.

Conclusion:

Our data show that glove perforation is unexpectedly common and underestimated in terms of unfavorable surgical outcomes. The rate of surgical site infections is increasing and we suggest that unrecognized glove perforation must be considered as a risk factor for surgical site infection after cesarean section.

Insights

Microscopic glove perforations during cesarean deliveries are common and significantly increase the risk of surgical site infections (SSI). Unrecognized glove defects are a critical, underestimated factor contributing to postpartum infections, necessitating improved prevention strategies.

Area of Science:

Obstetrics and Gynecology
Surgical Safety
Infectious Disease Prevention

Background:

Surgical site infections (SSI) complicate 1-4% of cesarean deliveries, with contamination risk reduced by aseptic techniques.
Glove perforations, occurring in nearly 30% of procedures, are an underestimated risk factor for postoperative infections.

Purpose of the Study:

To prospectively investigate glove perforation rates during cesarean deliveries.
To analyze the impact of unrecognized glove perforations on surgical site infection (SSI) rates.

Main Methods:

Collected and examined 1,779 pairs of surgical gloves from cesarean sections for macro and micro perforations.
Used a water-fill test to identify micro-perforations in gloves without visible holes.
Analyzed superficial SSI rates in groups with and without glove perforations.

Main Results:

Macro perforations were found in 9.4% of operations; micro-perforations were identified in 5.4% of remaining gloves.
SSI occurred in 21.8% of women with glove perforations versus 2.2% without (p < 0.001).
Glove micro-perforation was an independent predictor of SSI (aOR: 12.705, p < 0.001), even after adjusting for confounders.

Conclusions:

Glove perforation is a common and underestimated issue in cesarean deliveries.
Unrecognized glove perforations are a significant risk factor for surgical site infections.
Consideration of glove integrity is crucial for reducing SSI rates post-cesarean section.

Read full analysis

Keywords:

Cesarean Section Surgical Site Infection Surgical glove perforation

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