Surgical site infections associated with crash cesarean sections

In obstetrics, crash cesarean sections (CCS) are emergent scenarios that pose imminent threat of death or disability to the fetus and mother. There is a gap in literature regarding CCS prevalence, management, and complication prevention.

To quantify the prevalence and factors associated with increased risk of surgical site infection (SSI) following CCS.

A case-control study using a random sample of 500 cesarean sections (CS) performed between 2019 and 2021 at the Women's Hospital in Winnipeg, MB was performed. Cases of CCS complicated by SSI were identified and compared with controls who had a CCS without associated SSI.

Of the 500 CS sampled, 143 (28.6%) qualified as CCS. Of these, the incidence of SSI was 7.7% (n = 11). Duration of rupture of membranes (ROM) is associated with SSI following CCS, with duration of ROM being 63.7±94.4 hours among cases (n = 11) compared to 12.4±20.8 hours among controls (n = 132, P = 0.003). Administration of intrapartum antibiotics for indications excluding a positive group B streptococcus result, is also correlated with increased risk of infection following CCS, with antibiotics being administered prior to the CCS in 54.5% (n = 6) of CCS resulting in infections, as compared to 10.6% (n = 14) of CCS without (P = 0.0011).

SSIs are common following CCS, and this study identified both the prevalence of CCS and clinical characteristics that increase a patient's risk of infection following CCS. Optimal strategies to mitigate infections following CCS remain an important question for future research.