NECROTIZING FASCIITIS AFTER CESAREAN DELIVERY

Objective: To review our experience with the diagnosis and management of necrotizing fasciitis after cesarean delivery. Methods: We reviewed medical records of women with serious post-cesarean wound infections at the University of Alabama at Birmingham between 1987 and 1994 to id entify women with necrotizing fasciitis. The diagnosis of necrotizing fasciitis required intraoperative identification of necrotic fascia in febrile women undergoing post-cesarean wound debridement. Results: Du ring the study period, 5048 women had cesarean deliveries, nine of whi ch were complicated by necrotizing fasciitis. The mean (+/- standard d eviation) maternal age was 27 +/- 6 years, and the mean maternal weigh t was 199 +/- 64 lb. None of the patients had insulin-dependent diabet es mellitus, and none had known peripheral vascular disease. There wer e no intraoperative complications at cesarean delivery. The mean time from cesarean delivery to the diagnosis of necrotizing fasciitis and r eoperation was 10 +/- 4 days (range 5-17). All patients had surgical d ebridement upon consideration of the diagnosis, and all received broad -spectrum antimicrobial therapy. Results of wound cultures were availa ble in seven of the women, and all seven were found to have polymicrob ial infections. There were two mortalities, one as a result of metasta tic breast cancer and another with complications of sepsis. Conclusion : Necrotizing fasciitis is infrequent (1.8 per 1000 women) after cesar ean delivery at our institution, but it does result in appreciable mor bidity and mortality. Copyright (C) 1997 bit The American College of O bstetricians and Gynecologists.