POST CESEREAN WOUND SEPSIS: Recognizable Risks and Causes at a Rural Ugandan Hospital

Abstract

Gideon K Kurigamba, Dianah Namara, Irene Nanyanga, Haven Nahabwe, Birungi R Mutahunga

Post cesarean wound sepsis refers to a superficial surgical site infection that occurs within 30 days of the operative procedure and involves only the skin or subcutaneous tissue of the incision, and at least a purulent drainage from the incision or isolation of Organisms on culture or one of the cardinal signs of inflammation.

Wound sepsis increases morbidity, mortality and length of hospital stay (Oliver, et al). In Uganda, rates of severe wound infection are as high as 25% [1]. Caesarean section rates at the Bwindi community Hospital are 30% of the total deliveries.

Purpose: To determine the factors associated with post cesarean wound sepsis among mothers at Bwindi Community Hospital.

Methods: This was a retrospective cross sectional study. Consecutive sampling was used to obtain 50 files of mothers who got post cesarean wound sepsis and a matching equal sample of controls at Bwindi Community Hospital from July 2015 to June 2017.

Results: The rate of post caesarean sepsis was 3.5%.Multiple factors were associated with postoperative wound sepsis; Age between 26-30 years(OR 3.46, p0.008), Parity of greater than 5(OR 3.14, p0.010), Duration of labor of 5 -8hrs or greater (OR 10.67, p0.013), delayed time of ambulation greater than 24-72hrs (OR 0.14, p<0.001), intra operative blood loss of 500- 1000mls or greater(OR 8.00, p0.023) and Post-operative administration of ampicillin and metronidazole (OR40.00,p<0.001).

Conclusion: Post-operative wound sepsis in caesarean section is a relatively common occurrence in low-resource settings and mitigation of the multiple identified modifiable associated factors will greatly reduce patient morbidity and improve their outcomes.

PDF