From the Guidelines
A CT scan with a pelvic air-fluid collection after cesarean section should be promptly evaluated and managed as a potential postoperative abscess or infected hematoma, with consideration for broad-spectrum antibiotics and drainage of the collection. The management of such collections is guided by the principles outlined in the American College of Radiology's appropriateness criteria for radiologic management of infected fluid collections 1.
Key Considerations
- The detection and evaluation of fluid collections can be accomplished with CT or ultrasound (US), but CT provides the advantage of detecting deep collections and is usually the first-line modality in patients with fever of unknown origin 1.
- The use of intravenous (IV) and oral contrast with CT can help distinguish collections from adjacent vasculature or bowel, which is crucial for planning the appropriate intervention 1.
- Broad-spectrum antibiotics, such as piperacillin-tazobactam or a combination of ceftriaxone and metronidazole, should be initiated promptly to cover common organisms including skin flora, enteric gram-negative bacteria, and anaerobes.
- Drainage of the collection can be performed via CT-guided percutaneous approach or surgical intervention, depending on the size, location, and patient's clinical status.
- Close monitoring for signs of sepsis and adjustment of antibiotic therapy based on culture results are essential components of management.
Management Approach
- Laboratory tests including complete blood count, C-reactive protein, and blood cultures should be obtained before starting antibiotics to guide therapy and assess response.
- Antibiotic therapy should be continued for 7-14 days depending on clinical response, with adjustments made based on culture and sensitivity results.
- Early intervention is crucial to prevent progression to more severe infections like peritonitis or sepsis, which could significantly increase morbidity and mortality in the postpartum period.
From the Research
CT Scan with Pelvic Air-Fluid Collection after Cesarean
- A CT scan with pelvic air-fluid collection after cesarean section may indicate a postoperative complication, such as an infection or abscess 2.
- The presence of fluid collection in the pelvis after cesarean section is common, with a study finding that 49% of women had abdominal wound fluid collection after cesarean section 2.
- The pattern of fluid collection, whether septated or diffused, can determine the risk of postoperative wound infection and morbidity 2.
- Antibiotic prophylaxis is important in preventing post-cesarean section infections, with studies showing that single-dose antibiotic prophylaxis can be as effective as multiple-dose antibiotic prophylaxis 3, 4.
- Cefotaxime has been shown to be effective in treating endomyometritis after cesarean section, with a study finding that a dose of 6 g/day was more effective than 3 g/day 5.
- The use of ultrasonography to detect fluid collections and monitor postoperative morbidity after cesarean section may be a helpful tool in reducing postoperative complications 2.
Possible Causes and Complications
- Postoperative infection, such as endomyometritis or wound infection, can occur after cesarean section 6, 2, 3.
- Fluid collection in the pelvis can increase the risk of infection and abscess formation 2.
- The use of broad-spectrum antibiotics, such as cefotaxime, can help prevent and treat postoperative infections 6, 4, 5.
Diagnostic and Treatment Options
- CT scan or ultrasonography can be used to detect fluid collections and monitor postoperative morbidity after cesarean section 2.
- Antibiotic prophylaxis, such as single-dose or multiple-dose cefotaxime, can be used to prevent post-cesarean section infections 3, 4.
- Treatment of postoperative infections, such as endomyometritis, may involve the use of broad-spectrum antibiotics, such as cefotaxime or clindamycin and gentamicin 6, 5.