# Wound Infection After Caesarean Section

> Wound infection after caesarean section for NEET-PG Obstetrics and Gynaecology, covering risk factors, prophylactic antibiotics, infection depth and management.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/wound-infection-after-caesarean-section
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Williams Obstetrics; Dutta's Textbook of Obstetrics; Shaw's Textbook of Gynaecology
- How to cite: "Wound Infection After Caesarean Section", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/wound-infection-after-caesarean-section

## Direct answer

Wound infection after caesarean section is a surgical site infection of the incision or deeper tissues that develops within about 30 days of surgery. Risk rises with obesity, diabetes, labour, emergency surgery and prolonged rupture of membranes. A single dose of prophylactic antibiotic given before the skin incision is the most effective preventive step.

## What you must remember

- **Superficial incisional infection:** Involves skin and subcutaneous tissue, presenting as redness, warmth and discharge from the incision, usually in the first week.
- **Deep incisional infection:** Involves fascia or muscle, with persistent pain, fever and a collection, and often needs opening and debridement.
- **Organ-space infection:** Includes endometritis, pelvic abscess and an infected haematoma, endometritis is diagnosed clinically, and collections are confirmed by imaging.
- **Prophylaxis:** Cefazolin 2 g intravenously, given within 60 minutes before skin incision, with a higher dose for heavier women per protocol.
- **Added azithromycin:** Recent guidance supports adding azithromycin to the cephalosporin for women in labour or with ruptured membranes.
- **Skin antisepsis:** Chlorhexidine in alcohol is preferred over povidone-iodine for skin preparation before incision.
- **Risk reduction:** Good wound closure, control of haematoma and glucose control in diabetes all lower the risk of infection.

## A stepwise pathway from wound check to imaging

Most infections are picked up in the first week, so a structured check of the wound at every postoperative visit matters. Treatment escalates from local care to imaging-guided drainage as the depth of infection increases.

1. **Examine the wound:** Inspect the incision daily in hospital and at follow-up for redness, discharge, separation of edges and tenderness.
2. **Classify the depth:** Decide whether the infection is superficial, deep incisional or organ-space, because the treatment differs at each level.
3. **Open and drain:** Open the superficial collection, remove the skin sutures or staples over it, and drain it with regular dressing changes.
4. **Send swabs:** Take a swab from the discharge to guide antibiotic choice, and use oral antibiotics per the local antibiogram for mild spreading cellulitis.
5. **Escalate for deep infection:** Give intravenous antibiotics, open the wound fully and debride any necrotic tissue.
6. **Image for organ-space infection:** Use ultrasound or CT to locate a pelvic collection, then drain it under imaging or surgically.
7. **Exclude necrotising infection:** Pain out of proportion to the findings, crepitus or rapid spread needs urgent surgical exploration.

## Where the exam tries to catch you

Questions focus on the timing of prophylaxis, the depth classification and the need to drain pus.

- **Trap:** Giving the antibiotic after the skin incision. — **Correct:** Prophylaxis works best when given before incision, so that tissue levels are high during surgery.
- **Trap:** Continuing antibiotics for several days after an uncomplicated elective caesarean as routine. — **Correct:** A single preoperative dose is standard for uncomplicated surgery, and extra doses are added only for specific indications.
- **Trap:** Calling fever in the first 48 hours a wound infection by default. — **Correct:** Early fever is often due to other causes such as atelectasis or dehydration, and wound infection usually appears later.
- **Trap:** Treating a superficial collection with antibiotics alone. — **Correct:** Pus must be opened and drained, because antibiotics alone do not clear a collection.

## Frequently asked questions

### What is the most effective measure to prevent wound infection after caesarean section?

A single dose of prophylactic antibiotic given before the skin incision is the most effective measure to prevent wound infection after caesarean section. Cefazolin is the usual first-line agent in standard guidance. Timing matters more than repeated doses for uncomplicated surgery.

### Which antibiotic is used for prophylaxis before caesarean section?

Cefazolin is the usual first-line antibiotic for prophylaxis before caesarean section, given as 2 g intravenously before incision, with a larger dose for heavier women. Azithromycin may be added for women in labour or with ruptured membranes. A beta-lactam allergy changes the choice of agent.

### How is a superficial wound infection after caesarean section managed?

A superficial wound infection is managed by opening the affected part of the incision, draining any collection and changing dressings regularly. Swab results guide oral antibiotics when cellulitis is spreading. Antibiotics alone rarely clear a pus collection.

### When should a wound infection after caesarean section be imaged?

Imaging is needed when fever or pain persists despite wound care, because this suggests an organ-space infection such as a pelvic abscess. Ultrasound or CT locates the collection so that it can be drained. Imaging also helps exclude a haematoma that is mimicking infection.