Surgical site infections after cesarean delivery

Surgical site infections represent a persistent and clinically relevant complication of cesarean delivery, contributing substantially to postpartum morbidity, hospital readmission, and pregnancy-related mortality. As cesarean delivery has escalated to the most common major operation worldwide-now comprising 21% of global births and 32% in the United States-the burden of postcesarean surgical site infections, reported in 3% to 15% of cases, remains unacceptably high despite advances in perioperative antisepsis, antibiotic prophylaxis, and prevention bundles. This review provides an updated comprehensive overview of postcesarean SSIs, including their definitions, risk factors, microbiology, clinical presentation, evaluation, prevention strategies, and management. Postcesarean surgical site infections are classified as superficial incisional, deep incisional, organ/space infections such as postpartum endometritis, and necrotizing soft tissue infections. The microbiologic spectrum varies by infection type and includes both monomicrobial and polymicrobial pathogens. Clinical presentations range from localized incisional symptoms to systemic signs, with necrotizing soft tissue infections requiring urgent recognition due to their aggressive clinical course and high mortality. Key risk factors include prolonged rupture of membranes, labor, higher body mass index, intra-amniotic infection, and longer operative time. Prevention necessitates a multifaceted approach. In the preoperative phase, interventions include patient preparation and operative field antisepsis. Intraoperative strategies focus on surgical technique. Postoperative care centers on appropriate antibiotic prophylaxis and wound management. For established surgical site infections, the cornerstone of management is timely incision and drainage. Meticulous wound care, often involving serial dressing changes or negative pressure wound therapy, supports appropriate healing. Targeted antibiotic therapy is initiated when systemic signs or extensive local findings are present and is tailored to the specific clinical scenario. Addressing surgical site infections associated with cesarean delivery requires a comprehensive, multidisciplinary, and evidence-based approach. A sustained commitment to optimizing and implementing refined protocols is imperative to improve maternal infectious outcomes.