Publication:

Factors associated with superficial surgical site infection after emergency cesarean section at Befelatanana University Hospital, Madagascar: a retrospective case-control study

Background Surgical site infection (SSI) after emergency cesarean section is a preventable cause of maternal morbidity and additional cost, especially in resource-limited maternity hospitals. This study aimed to identify factors associated with superficial incisional SSI after emergency cesarean section at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar.

Methods A retrospective case-control study was conducted from January 2020 to December 2021. Cases were women treated for superficial incisional SSI within 30 days after emergency cesarean section at term. Controls were women without SSI, selected at a ratio of two controls per case. Data were extracted from hospital records, antenatal cards, registers and interviews. Odds ratios (ORs), 95% confidence intervals (CIs) and p values were calculated.

Results Among 12,708 deliveries, 4,857 were cesarean sections, including 3,897 emergency procedures. Sixty superficial SSIs were identified, giving a frequency of 1.5%; 120 controls were included. Factors significantly associated with SSI were age ≥35 years, absence of antenatal care, BMI ≥25 kg/m2, premature rupture of membranes, membrane rupture ≥12 hours, labour ≥12 hours, operation duration ≥60 minutes, blood loss ≥1000 ml and operation by a specialist trainee.

Conclusions Superficial SSI after emergency cesarean section was multifactorial. Strengthening antenatal care, timely labour management, optimized antibiotic prophylaxis, senior supervision, infection-prevention bundles and post-discharge wound surveillance may reduce post-cesarean SSI in this setting.