Reducing post-cesarean sepsis: Current best practice in prevention and treatment

Cesarean section is the most common surgical procedure performed worldwide. It is associated with good perinatal and maternal outcomes when indicated. The rising global cesarean birth rate has coincided with an increase in post-cesarean sepsis - specifically site infections, which have an incidence of 7% worldwide. Post-cesarean sepsis remains a serious complication that prolongs hospital stays, resulting in additional surgery and worsening maternal morbidity and mortality, and increasing healthcare costs with socioeconomic consequences. There is no global practice guide for post-cesarean sepsis, despite most maternal deaths due to sepsis occurring postpartum. Here we introduce a FIGO Committee on Infections During Pregnancy guide on prevention and treatment of post-cesarean sepsis. We encourage strategies to keep cesarean birth rates at evidence-based levels by aiming to standardize the management of labor and to increase the percentage of vaginal births after a previous cesarean. Identification of risk factors before and during the surgery is the primary step towards prevention. These measures, combined with evidence-based strategies to promote infection prevention practices, including routine prophylactic antibiotics, skin and vaginal preparation before cesarean birth, and glove change prior to skin closure, contribute towards reducing maternal morbidity and mortality.