Optimizing Surgical Wound Care in Obstetrics and Gynecology

Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study

OBJECTIVE

To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth.

DESIGN

Nationwide population-based cohort study.

SETTING

Sweden.

POPULATION

Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001-2019.

METHODS

Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth.

MAIN OUTCOME MEASURES

Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).

RESULTS

In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11-3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53-15.24) of recurrent OASI.

CONCLUSIONS

Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.

Necrotising fasciitis presenting as a blister: A case report on improving early recognition of surgical site infection following caesarean delivery

Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.