Management of 1-Week Postpartum Cesarean Section with Drainage and Dehiscence
Immediately drain the fluid collection, assess for infection versus seroma, and initiate appropriate wound care with healing by secondary intention—antibiotics are only indicated if there are clear signs of infection with systemic involvement. 1
Initial Assessment and Diagnosis
The first critical step is distinguishing between an infected wound and a sterile seroma:
- Seroma characteristics: Fluctuant swelling with serous drainage, minimal erythema, no systemic signs (fever <38.5°C, heart rate <110 bpm), and absence of purulent discharge 1
- Surgical site infection (SSI) characteristics: Purulent drainage, pain, tenderness, erythema extending >5 cm from wound edge, induration, fever >38.5°C, or tachycardia >110 bpm 1
- Wound dehiscence: Separation of the incision layers, which may occur with or without infection 2
Primary Treatment Algorithm
For Sterile Seroma (No Infection Signs)
Prompt drainage is the cornerstone of treatment:
- Open part of the incision to allow complete drainage of the fluid collection 1
- Initiate wound care with dressing changes to promote healing by secondary intention 1
- Do NOT use antibiotics for uncomplicated seromas without infection signs 1
- Monitor the wound until complete healing occurs 1
For Infected Wound (SSI Present)
If systemic signs of infection are present:
- Drain any fluid collections and open the wound as needed 1
- Initiate antibiotic therapy with cefazolin (first-generation cephalosporin) as it provides appropriate coverage for skin and soft tissue pathogens including S. aureus and Streptococcus species 3, 4
- For penicillin-allergic patients, use gentamicin/clindamycin combination 4
- Continue antibiotics until systemic signs resolve and wound shows improvement 1
Advanced Wound Management
For Recurrent or Large Seromas
- Consider negative pressure wound therapy (NPWT) which promotes granulation tissue formation and obliterates dead space 1
- NPWT has demonstrated significant reduction in SSI (pooled OR 0.25; 95% CI 0.12-0.52) 1
- This can be managed in an outpatient or home setting with appropriate nursing support 5
Wound Care Technique
- Perform regular dressing changes to maintain clean wound bed 1
- Allow healing by secondary intention rather than attempting primary reclosure 1
- Monitor for signs of worsening infection or failure to heal 1
Critical Pitfalls to Avoid
Common errors that worsen outcomes:
- Never use prophylactic antibiotics for sterile seromas—this promotes antibiotic resistance without benefit 1
- Avoid premature wound reclosure—wounds with dehiscence and drainage require healing by secondary intention 1
- Do not place subcutaneous drains prophylactically in already dehisced wounds—drainage is achieved by opening the incision 2, 6
- Avoid inadequate drainage—incomplete evacuation of fluid collections leads to recurrence 1
Monitoring and Follow-Up
Serial assessment is essential:
- Evaluate wound healing progress at regular intervals (every 2-3 days initially) 1
- Watch for development of infection signs if initially presenting as sterile seroma 1
- Monitor for systemic complications including fever, increasing pain, or spreading erythema 1
- Continue follow-up until complete wound healing is achieved 1
Special Considerations
Risk factors that may complicate healing:
- Obesity increases risk of wound complications and may require more aggressive management with NPWT 6
- Diabetes, chorioamnionitis, and prolonged labor are independent risk factors for poor wound healing 4
- Thick subcutaneous tissue (>3 cm) may benefit from NPWT to prevent recurrent fluid collections 2
Note on imaging: MRI has superior soft-tissue contrast for detecting myometrial defects and can distinguish true dehiscence from normal postoperative changes, though this is rarely needed for superficial wound management 2