Pregnancy-related sepsis leads to an estimated 75 000 maternal deaths worldwide each year, with most of these deaths occurring in low and middle-income countries. According to the 2015 Saving Mothers Annual Report, pregnancy-related sepsis remained the third leading cause of direct maternal deaths in South Africa.
Causes
Infections occur when bacteria enter the wound. Staphylococcus aureus is the most common cause of post-caesarean wound infections, causing an estimated 15%-20% of cases. Common symptoms of post-caesarean wound infections can include tenderness, redness, fever, and pain.
Staph bacteria naturally live on the hair and skin. When they multiply and enter a wound, they can cause several types of post-caesarean wound infection:
- Impetigo. Impetigo causes shallow, fluid-filled blisters that rupture and leave behind honey-coloured crusts. It can be very painful and itchy
- Abscesses. Abscesses are sores filled with dead skin and pus that develop under the skin. They may feel warm and painful
- Cellulitis. The symptoms can quickly spread from the incision site outward and is typically painful, red, and warm to the touch.
Wound infections usually arise after four to seven days. When the symptoms begin within 28 hours, Streptococcus bacteria may be the cause. Strep infections can cause erysipelas. This is a type of cellulitis that also involves the lymph system. Women with erysipelas typically have red, shiny, raised lesions with clear margins. Other bacteria that can cause infections in caesarean wounds include:
- Ureaplasma urealyticum
- Staphylococcus epidermidis
- Enterococcus faecalis
- Escherichia coli
- Proteus mirabilis.
Symptoms
Women should check the wound each day for any signs of infection. Many types of infection do not cause symptoms until four-seven days after the surgery, when they have already returned home from the hospital. The symptoms of post-caesarean wound infections vary from mild discomfort to extreme pain depending on the type and severity of the infection. Some of the most common symptoms of post-caesarean section wounds include:
- Fever
- Tenderness
- Redness
- Swelling along or near the incision site
- Pain
- Pus or other discharge
- Hardening of the skin.
Complications
Staph infections usually stay on the skin's surface, although they can also travel to the bloodstream and affect other organs. Possible complications associated with staph infections include:
- Endocarditis
- Osteomyelitis
- Bacteremia.
Staph bacteria can also cause toxic epidermal necrolysis, which is a serious infection that causes large patches of the skin to peel. In rare cases, Streptococcus pyogenes can cause severe necrotising fasciitis. This destroys the skin and underlying tissues. Necrotising fasciitis causes fever and extreme pain that increases rapidly over time. Some women also notice the skin and other tissues become redder or hardened.
REFERENCES: Medical News Today, Stellenbosch University
