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Postpartum Infection in Morbidly Obese Women After C-Section: Does Early Prophylactic Oral Antibiotic Use Make a Difference?

Yeeles H, Trinick S, Childs C, Soltani H and Farrell T

The rising prevalence of morbid obesity particularly in women coupled with a higher likelihood of having a caesarean section (C-section) birth and an increased risk of Surgical Site Infection (SSI) places wound assessment among priority areas in maternity care. There is a level of ambiguity about the efficacy of routine preventative care pathways particularly in morbid obese women with regards to SSI after caesarean section. A pilot study was therefore undertaken to explore the number of women with a C-section infection in a cohort of morbidly obese women during six weeks postpartum against a background of standard care early antibiotic prophylaxis and skin closure practice. A short questionnaire was sent to 59 women with an early pregnancy BMI ≥ 40 who gave birth via C-section in a large maternity unit in Sheffield, UK. Of 39 participants who responded, 20 (51%) developed a post-operative wound infection within 6 weeks postpartum. Infections were higher in the women who had emergency C-section births (14/24, 60%). There was no significant difference in wound infection risk with respect to wound closure material (Chi-square = 0.298, p-value = 0.86) or the use of oral prophylactic antibiotic after birth (Chi-square = 0.2053, p-value = 0.650). Although all the women received routine IV antibiotics before C-section, only 26/39 received the 5 day oral antibiotic prophylaxis after birth. Six of 13 women who did not receive postpartum oral antibiotics (46%) developed a SSI. In summary, over half of morbidly obese women who delivered by C-section developed a wound infection, despite receiving prophylactic antibiotics. We acknowledge the limitations of these results from a small sample retrospective observational study. However this may indicate that SSI imposes a greater risk because of a lack of antibiotic prophylaxis efficacy and requires further investigation.