C-Section Scar Wound Infection

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A C-section scar infection may occur in 3-15% of women who deliver through a C-section. The number of women giving birth through C-sections has increased significantly in the past few decades (1). A prompt diagnosis and management of C-section scar infection can help improve its prognosis and prevent complications.

Read this post to learn more about the causes, signs, diagnosis, treatment, and prevention of C-section scar infection.

In This Article

What Is A C-Section Wound Infection?

C-section scar infection should be seen by a doctor
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A c-section wound infection, also known as post-cesarean section wound infection, is a bacterial infection that develops after cesarean  delivery. It is due to bacterial infecting the surgical site (2).The infection could usually happen due to numerous types of bacteria and may be a superficial skin infection or a more dangerous deeper pelvic wound abscess. It is essential to be seen by a doctor as soon as possible to diagnose and treat the problem

What Are The Causes Of Infection After Cesarean Birth?

The following are risk factors for a wound infection (3) (4) (5):

  • Obesity
  • Increased weight
  • Previous cesarean delivery
  • Diabetes
  • An infection called intraamniotic infection that developed during labor
  • Prolonged rupture of membranes
  • Repeated vaginal examinations
  • An emergency Cesarean delivery

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Tobacco use, insufficient or limited prenatal care, twin pregnancy, the prolonged second stage of labor, and excessive blood loss are some other risk factors for infections after a cesarean section (5).

Knowing the symptoms of a c-section infection can help you start the treatment in time.

What Are The Signs Of A Post-Cesarean Wound Infection?

Lower abdominal pain after the surgery may indicate infection
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The following are a few symptoms of an infection after c-section.

  1. Fever and possible chills typically  with a temperature higher than 100.4 F can be one of the symptoms of a c-section infection. Swelling, redness, or increased pain around the incision or surgical site. Any fluid coming out from the incision, an opening of the incision, and malodorous vaginal discharge are also c-section infection symptoms (6).
  1. Discomfort or pain in the lower abdomen region for several days after the surgery.
  1. Heavy bleeding and difficulty while urinating are also signs of a c-section infection. In addition to this, you could experience pain and a burning sensation while urinating, and blood in the urine if you have developed an infection (7).

If you have noticed any of these symptoms, consult your doctor for a proper diagnosis.

How Is A Post-Cesarean Wound Infection Diagnosed?

The doctor would check for tenderness, fever, swelling, or any other sign that could indicate an infection. Daily inspection of the incision site is the most vital part of the postoperative diagnosis. However, most of the infections start to appear after a week of surgery. Therefore, doctors advice new mothers to be attentive to these signs. If you see the symptoms, visit the doctor for further diagnosis and timely treatment (8).

How To Treat A Wound Infection?

Oral antibiotics are used in the early stages to treat infection
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A c-section infection can be treated using (5):

  1. Antibiotics: Doctors usually recommend treating cesarean wound infections such as cellulitis with antibiotics. If caught early, oral antibiotics are used, however for more advanced cases, intravenous antibioticsiXAntibiotics administered into a vein via an injection or catheter to treat or prevent bacterial infections may be necessary.
  1. Drainage: For cases where there is a pocket of abscess or pus, opening the skin incision to allow drainage of the infection may be warranted.

Faith Womack, a mother of two from the USA shares her experience of getting infection after cesarean birth. She says, “A month after birth, my C-section wound became infected. My whole abdomen became red, inflamed, and bloated and I was in a lot of pain.

“Finally my husband got me an appointment with my doctor and the doctors told me, ‘Yes, you’re infected.’ She drew the line around the infection and it was just 2 inches above my incision. She prescribed me some antibiotics and told me to come back after a week. But it got worse in two days. I was in so much pain that I can barely breastfeed my child. So I went to the obstetrics clinic again and my doctor told me that I’ll have surgery today.” She later had surgery (i).

  1. Dressing the wound: Some infection conditions may require dressing the wound regularly to close the wound and promote healing.

The treatment can be effective and your recovery faster when you follow a few tips.

How to take care of a C-Section Infection Wound?

Consume healthy food and lots of liquids
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Here are some things that you need to take care of.

  • Take and complete the antibiotics.
  • Go for regular cleaning and dressing of the wound as directed.
  • Avoid applying any lotions or creams that may contain chemicals harmful to your skin. And wear loose and lightweight clothes that don’t rub on your wounds.
  • You can always get postpartum medical care from your doctor if the wound doesn’t seem to heal or if you experience more pain at the surgical site.
  • Consume healthy food and lots of liquids.

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If the doctor has applied tape on your incision, let it fall down on its own. It may take about a week (16).

Keep reading to learn how you can prevent an infection or minimize its risk.

C-Section Scar Healing Stages

The following are the three different stages for a C-section scar to heal:

  1. Inflammatory Stage: The initial stage, known as the inflammatory phase, usually lasts a few days following a c-section. This is the point at which the bleeding stops and the body sends white blood cells to the site of the wound to prevent infection. You may notice some swelling and a reddish or pinkish color at the incision site during this phase. Keep an eye out for any signs of infection.
  2. Proliferative Stage: At this stage, fibroblast cells gather and multiply at the site of the incision. These cells perform an important role in strengthening the incision site and bringing its edges closer together by making collagen. As this occurs, the c-section scar gets thicker and as it contracts, the color changes. The phase lasts for about three to four weeks.
  3. Remodeling Stage: At this stage, the once dense and puffy scar tissue progressively flattens and loses its color. This is the time when the c-section scar is expected to diminish and improve in appearance. The stage may last for months to years (9).

Can You Prevent C-Section Wound Infection?

Control gestational diabetes to reduce c-section scar infection
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You may not be able to entirely prevent the infection after a c-section , but you can take certain precautions to avoid any complications.

  1. Maintain a healthy weight: Obesity is one of the risk factors of a c-section wound infection (3). Hence, pregnant women should try maintaining their weight during pregnancy by exercising or consuming a healthy diet.
  1. Control diabetes: Gestational diabetesiXA condition where the pregnancy's hormonal and physical changes interfere with the body's use of insulin, causing an elevated blood sugar could cause more complications related to the infection after a c-section (10). Therefore, pregnant women should try keeping their glucose levels in check.
  1. Treat other conditions/diseases: If you are suffering from any disease/illness or have any pre-existing conditions that may trigger complications with a c-section infection, try to treat them before the due date.

Frequently Asked Questions

1. Why does my C-section scar hurt?

In rare cases, the endometrial tissue grows at the site of a C-section scar. This tissue may grow outside or inside the uterine walls, hurting the scar. Treatment may involve medical or surgical intervention (11) (12).

2. How many C-sections can a woman have?

Every woman is unique, and so is their body. Since the risk of C-sections starts increasing after the third cesarean, experts recommend that women can have a maximum of three C-sections (13).

3. Is it normal for a C-section incision to pus?

No. While you may experience swelling and redness at the incisioniXA cut in the body made for surgical purpose site after cesarean delivery, pus seeping out from the incision site is a sign of surgical site infection (6).

4. Can internal stitches open after C-section?

Yes. The internal cesarean incision on the uterus can also open or rupture following a cesarean delivery. However, its occurrence is rare (14).

5. How many layers are cut during C-section?

During a cesarean section, three layers of the uterus, including the serosal outer layer (perimetrium), the muscle layer (myometrium), and the inside mucosal layer (endometrium), are incised (15).

C-section scar infection is uncommon, but being obese, repeated or emergency cesarean delivery, diabetes, intraamniotic infectioniXInflammation of the placental and embryonic membranes caused by a bacterial infection , and many other factors may increase its risk. It is a bacterial infection that can be superficial or have a more severe deeper pelvic wound abscessiXA swollen area of skin filled with pus and debris resulting from a bacterial infection . However, with adequate medical treatment, it can be managed. So, if you experience any symptoms, see a doctor specializing in obstetrics and gynecology for the diagnosis as soon as possible. To reduce the risk of infection, take proper care of the C-section wound and visit your doctor if you have any concerns.

Infographic: Infection After C-Section: Additional Risk Factors And Complications

Although C-section has become a common surgical mode of delivery, post-surgery healing is not easy as you could be exposed to infections in the incisional region. Here is an infographic with the possible risk factors and complications following an infection after C-section.

other risk factors and complications of c-section scar wound infection (infographic)

Illustration: Momjunction Design Team

Get the high-quality PDF version of this infographic.

Download Infographic in PDF version

Key Pointers

  • A C-section scar infection develops post-cesarean delivery, resulting from obesity, diabetes, etc.
  • Fever, abdominal pain, and bleeding may indicate an infection and needs immediate attention by a doctor.
  • Cleaning and dressing the wound regularly would promote healing.
  • To avoid C-section scar infection, a pregnant woman should maintain her weight and keep other health issues in control.

Learn about post-cesarean infection and antibiotic prophylaxis in this informative video. Understand the risks and how to prevent them with the right treatment.

Personal Experience: Source

References

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.

1. K. B. M Saeed, R. A. Greene, P. Corcoran, and S. M. O’Neill; Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol; BMJ Open: National Center for Biotechnology Information (2017)
2. M. M. Osela; Study on Post Caesarean Section Wound Infection at Misurata Central Hospital and Al-Khoms Teaching Hospital, Libya; IOSR Journal of Dental and Medical Sciences (2016)
3. S. N. Conner; Maternal Obesity and Risk of Post-Cesarean Wound Complications; American Journal of Perinatol (2014)
4. Jido TA, Garba ID. Surgical-site infection following cesarean section in Kano, Nigeria. Ann Med Health Sci Res 2012;2:33-6.
5. T. Kawakita and H. J. Landy; Surgical site infections after cesarean delivery: epidemiology, prevention and treatment; Maternal Health, Neonatology and Perinatology (2017)
6. Cesarean Wound Complications; Department of Obstetrics and Gynecology Cesarean Wound Complications: University of Michigan Health System
7. When to call your doctor after cesarean; Health Pages (2018)
8. S. Zuarez-Easton, N. Zafran, G. Garmi, and R. Salim; Postcesarean wound infection: prevalence, impact, prevention, and management challenges; International Journal of Women’s Health (2017)
9. C-section Scars; Birth Injury Help Center
10. E. T. Martin et al.; Diabetes and Risk of Surgical Site Infection: A systematic review and meta-analysis; Infection Control & Hospital Epidemiology (2015)
11. Fatimah Alnafisah et al.; Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature; National Library of Medicine (2018)
12. Dah-Ching Ding and Senzen Hsu; Scar endometriosis at the site of cesarean section; National Library of Medicine (2006)
13. How Many C-Sections Can A Woman Have? Vital Record
14. Uterine Rupture; Cleveland Clinic
15. Sharon Sung and Heba Mahdy; Cesarean Section; StatPearls [Internet]; National Library of Medicine (2022).
16. The Do’s and Don’ts of Healing from a C-Section; Intermountain Healthcare.

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