الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Infectious complications following obstetric surgical procedures are considered a significant source of maternal morbidity and even potential mortality.
As the cesarean birth rate continues to rise in most developing countries, postpartum infectious morbidity will become an even more significant problem.
Cesarean section is considered the most important risk factor for postpartum infection. Women undergoing cesarean section have a 5 to 20-fold greater risk for infectious morbidity compared with a vaginal birth.
Infectious complications following cesarean birth include fever, wound infection, endometritis, and urinary tract infection. There can also occasionally be serious infectious complications including pelvic abscess, bacteremia, septic shock, necrotizing fasciitis and septic pelvic vein thrombophlebitis, resulting in major financial burdens and maternal mortality
Surgical Site infection defined according to the Centers for Disease Control and Prevention (CDC) criteria as a superficial or deep surgical site infection occurs after a CS, being one of the most common complications that may lead to wound dehiscence or systemic infections in case of lack of sufficient prophylaxis or inappropriate treatment. Increased morbidity, prolonged hospitalization time, increased rate of hospital readmissions and growing treatment costs are all consequences of the above.
This study is a randomized control study which was conducted at Minya General Hospital, Minya governorate, Egypt, between January 2017 and January 2018 in which, we are applying some preventive measures including proper skin cleansing and proper prophylactic antibiotic prior to operation , thus decreasing incidence of post-cesarean infectious complications. In addition to identifying some risk factors for post-cesarean infectious morbidity and therefore applying special strategies aiming to decrease incidence of developing infection.
The study included any female in the child bearing period of gestational age 37 weeks or older with viable fetus, and both elective and emergency CS.
In this study all patients were subjected to the following steps:
* They had the same level of surgical team, methods of sterilization of surgical team, surgical technique for CS, skin suture type and the same suture material.
* Each patient received 1 gm. 3rd generation ceohalosporins i.v.
o Following anesthesia, urethral catheterization was done under complete aseptic conditions.
o Scrubbing of the skin with antiseptic solution ( Betadine).
o Opening of the abdomen through Pfannenstiel abdominal incision.
o Opening of subcutaneous tissue and opening of rectus sheath through a transverse incision then separation of the recti muscles.
o Good exposure of lower uterine segment to be opened by a C-shaped incision.
o Delivery of the baby &clamping of the cord, followed by administration of oxytocin.
o Complete delivery of the placenta with assisted spontaneous delivery of the placenta with controlled cord traction.
o Closure of the uterus in two layers and ensure good hemostasis.
o Approximation of the recti muscles &closure of the rectus sheath.
o Closure of subcutaneous fat if more than 2cm thickness and closure of the skin by subcuticular sutures.
o Cover surgical incisions with an appropriate sterile pad dressing at the end of the operation.
o Use an aseptic non-touch technique for changing or removing surgical wound dressings.
o Follow up of the patient & discharged after confirmed +ve intestinal motility.
Postoperatively, maternal temperature is measured on 2 separate occasions 6 hours apart with exclusion of the first 12 hours following surgery. The wound is inspected 48 hours, 7 days and 30 days after caesarean section for signs of superficial or deep incisional surgical site infection, observation for endometritis (uterine tenderness, purulent drainage from the uterus, abdominal pain, fever or organism cultured from fluid, and detection of urinary tract infection with suprapubic tenderness, fever or positive urine culture.
The total number of women who fulfilled our criteria was 1500, of whom 250 women developed post-cesarean infectious morbidity mainly in the form of SSI, representing an incidence of 16.7 %.
This study revealed some risk factors which may contribute to developing infection. These risk factors are:
1) Age; risk for infection increases with increasing age.
2) BMI; increasing BMI (>30 kg/m2 ) increases incidence of infection.
3) Previous CS; increasing number of previous scars is associated with increasing in incidence of developing postoperative infection.
4) Diabetes mellitus in this study represents high risk for infection postoperatively.
5) Indication of CS has an important role in infectious morbidity post-operative, in this study 250 women developed infection, 130 women “representing 52%” of them were having emergency cesarean section.
6) Rupture of membrane; the odds of SSI were increased by 9.441(with significant P-value < 0.001) among mothers who had prolonged rupture of membrane before CS.
Our study thus addressed several concerns regarding the prophylactic use of antibiotics together with proper skin cleansing, in particular, in the presence of one or more of the risk factors mentioned before.
There is lack of consensus regarding the timing of antibiotics prophylaxis in caesarean deliveries. The usual obstetric practice has been to administer these antibiotics at cord clamping. Concern has focused on the possibility that unnecessary fetal exposure might mask fetal infections and increase the need for a sepsis workup in newborn infants and the selection of resistant strains, with potential adverse effects on the baby. On the other hand, other studies revealed that giving antibiotics prior to surgery is superior to administration after umbilical cord clamping.
Understanding the risk factors associated with infectious morbidity post CS would help health care providers to rapidly identify women at highest risk and provide appropriate care in preventing such morbidity and help to strengthen both diagnosis and treatment among women at high risk.