Management of Wound Complications From Cesarean Delivery

Multiple factors account for the increasing number of cesarean delivery wound
complications; among them are an increase in cesarean delivery and an increase in the number
of overweight and obese patients.Wound complications from cesarean delivery are a significant
emotional and economic burden in obstetric care. The postpartum period is a challenging time
for women, as a result of stressors such as fluctuations in hormone levels, caring for a newborn
baby, and recovery from the actual delivery process. A postoperative wound complication further
intensifies an already difficult period of adjustment. The economic burden is difficult to quantify
but is likely significant.

Nutrition and nutritional supplementation to improve wound healing has been written
about extensively, especially in the area of chronic wounds. Many recommendations have been
made particularly with regard to vitamin C, A, and zinc. Adequate nutrition does seem essential
to proper wound healing. This fact is frequently overlooked but should be a priority of
postoperative management. Protein requirements during pregnancy are approximately 60 to 80
grams per day. Lactation increases those requirements by 5 grams per day. Surgical procedures
increase protein requirements above these levels causing ileus, which further worsens a
patient’s nutritional status that is why protein deficit can delay wound healing of the patient. That
is why it is important to health teach the patient regarding their nutrition after a cesarean
delivery.

The first step in prevention of wound infection starts with the preparation of the operative
site. Important to these suggestions is the fact that use of antibacterial wash needs to start
before surgical preparation of the patient in the operating room. Despite prophylactic measures
and good surgical technique, a small percentage of patients will still experience wound
complications. Wound management should consider strategies that expedite healing, minimize
complications and cost. Furthermore, principles of wound management should provide
treatment to decrease cofactors that impede healing. Hematomas and seromas are commonly
observed problems after a cesarean delivery. These types of situations require manual opening
of the wounds to allow drainage but always remember to tell the patient on asepsis technique of
cleaning the surgical wound. After infection has been treated and all of the hematoma/seroma
evacuated, an open wound can be managed in 3 ways: secondary closure, secondary intention
with dressings, and secondary intention using negative pressure wound therapy. Healing
through secondary intention has historically been the most common way to manage wound
disruption. The rise in the incidence of chronic wounds has encouraged the development of new
wound care strategies and products to improve on the health teaching to the patients on the old
“wet to dry” dressings.
References:
Sarsam, S. Elliot, J. & Lam, G. (2005). Management of Wound Complications From Cesarean
Delivery. Retrieved from
https://journals.lww.com/obgynsurvey/Abstract/2005/07000/Management_of_Wound_Complicati
ons_From_Cesarean.28.aspx on June 27, 2022.