SURGICAL WOUND SITE OUTCOME IN ELECTIVE AND EMERGENCY CESAREAN SECTION - A PROSPECTIVE OBSERVATIONAL COMPARATIVE

STUDY.

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1 INTRODUCTION

2 REVIEW OF LITERATURE

3 AIMS & OBJECTIVES

4 MATERIALS & METHODS

5 RESULTS

6 DISCUSSION

7 CONSULATION

8 LIMITATIONS

9 BIBLIOGRAPHY

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Glossary Abbreviations

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INTRODUCTION

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INTRODUCTION

Caesarean section is one of the most common surgical procedures performed

globally. The incidence of cesarean deliveries, both repeat and primary, has risen dramatically

over the last few decades, with an estimated global number of 22.9 million cesarean deliveries in

20121, 2. In developed countries, the proportion of caesarean births was 21.1% , whereas in least

developed countries only 2% of deliveries were by CS according to 2007 estimates3. Post

partum period is a challenging time for women. Psychologically, it is the period she starts

experiencing motherhood. Physiologically, she starts adapting to new demands of the new born

and her own .However, pathology or complications at any stage in peri partum period may

jeopardize the whole process. Women experiencing delivery through Caesarean section are at

higher risk of complications than those through vaginal delivery. Surgical site infections are a

major contributor to morbidity and mortality in postsurgical care. Risk for surgical site infection

is multifactorial and includes a host of microbial, patient-related, and procedure-related factors4.

Cesarean wound infections represent a significant health and economic burden.

Several modifiable risk factors have been identified for their development. Understanding these

risks and techniques to manage cesarean wounds is essential5. In all the caesarean section

patients, depending on the definitions used and the period of observation, surgical site

infection (SSI) occur in about 1.8%–9.8% of these subjects which results in increased duration

of hospitalization and increased rates of morbidity with increased hospital readmissions6-13. The

rates of SSI are not only multifactorial but also highly dependent on the detection rates and the

definition of what an SSI is. Post-caesarean SSI extends hospitalization by about 4 days , and

also generates huge additional costs in treating patients13. Women undergoing Cesarean

delivery have a 5 to 20 fold greater risk of complication compared with Vaginal delivery 14.

Wound complications in caesarean section include Surgical site infection (stitch abscess,

6

cellulitis ) , seroma, haematoma, wound separation, wound dehiscence and rarely burst

abdomen15-18. Surgical site Infection predominates the picture. Infections are commonly

polymicrobial (caused by many organisms). Pathogens isolated from infected wounds and the

endometrium include Escherichia coli, group B streptococcus, Enterococcus faecalis, Staphylo-

coccus aureus and coagulase negative staphylococci, anaerobes (including Peptostreptococcus

species and Bacteroides species), Gardnerella vaginalis and genital mycoplasmas19.

Antimicrobial prophylaxis at the time of surgery has reduced the rate of postpartum endometritis

and wound infection after both nonelective and elective cesarean delivery20.

Wound complications delay the recovery, prolong the hospitalization,

necessitate the readmission or prolong outpatient treatment. Wound infection is the commonest

and most troublesome disorder of wound healing and despite modern surgical techniques and the

use of antibiotics prophylaxis, surgical site infections (SSI) remains a major contributory factor

of maternal morbidity and mortality. It is therefore important to identify and treat the comorbid

and risk factors along with predisposing factors which contribute to wound complications and

bring back the mother to optimal condition and hence decreasing the incidence of wound

complications. The risk factors for surgical site infections (SSI) after caesarean section are

many; these include intrinsic and extrinsic risk factors that predispose patients to SSI. Intrinsic

factors are patient related while extrinsic factors are related to patient care and management,

although the intrinsic factors cannot be changed, the risk they present in terms of infection is

identifiable and manageable.

Factors6, 10, 14, 21, 22 that have been associated with an increased risk of wound

complications among women who have a cesarean delivery include emergency cesarean

section21, labor and its duration, ruptured membranes and the duration of rupture, the

7

socioeconomic status of the woman, number of prenatal visits, vaginal examinations during

labor, urinary tract infection, anemia, blood loss, obesity, diabetes, the skill of the operator and

the operative technique7, 14, 21-24.

Schneid-Kofman N et al12 and Farret TC et al25 observed that Emergency caesarean

section is an independent risk factor for development of Surgical site infection. Farret TC et al25

observed that patients who had an emergency cesarean had a 3.3-fold greater risk of SSI. But the

literature comparing the incidence of surgical site infection in emergency versus elective

caesarean section is very limited. Also the incidence of surgical site infection in cases of

emergency LSCS is high, increasing the maternal morbidity26.

So we carried out our study with the objective of estimate the incidence of various

surgical wound site complications in elective and emergency cesarean section and to determine

the factors affecting various wound site complications in cesarean section so that the obtained

data can be utilized to design strategies helpful in minimizing the extrinsic risk factors and hence

decreasing the morbidity.

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AIMS & OBJECTIVES

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AIMS AND OBJECTIVES:

Aim: To study surgical wound site outcome in elective and emergency cesarean section

Objectives:

To study the incidence of various surgical wound site complications in elective and

emergency cesarean section. 

To determine the factors affecting various wound site complications in cesarean section.

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REVIEW OF LITERATURE

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REVIEW OF LITERATURE

1. INCIDENCE OF LSCS, ELECTIVE AND EMERGENCY2. WOUND COMPLICATIONS OF LSCS3. SSI – DEFINITION4. SSI – INCIDENCE , ELECTIVE Vs EMERGENCY5. SSI – RISK FACTORS6. MOST RELEVANT STUDIES

Delivery of the baby by an abdominal and uterine incision is

known as caesarean section. Lower segment Caesarean section is the one of most common

surgical procedure done in Obstetrics. Women undergoing Cesarean delivery have a 5 to 20

fold greater risk of complication compared with Vaginal delivery 14. Wound complications from

caesarean delivery are a significant emotional and economic burden. Caesarean section is one of

the most common surgical procedures performed globally. The incidence of cesarean deliveries,

both repeat and primary, has risen dramatically over the last few decades, with an estimated

global number of 22.9 million cesarean deliveries in 20121, 2. In developed countries, the

proportion of caesarean births was 21.1% , whereas in least developed countries only 2% of

deliveries were by CS according to 2007 estimates3.

The rates of caesarean section is on the rise in the last few decades There continues to

be an unprecedented rise in the Caesarean Section rates . Caesarean section (CS) rates continue

to evoke worldwide concern because of their steady increase, lack of consensus on the

appropriate CS rate and the associated additional short- and long-term risks and costs.

12

According to Global, Regional and National Estimates: 1990-2014 from 150

countries, Betran AP27 reported that 18.6% of all births occur by CS, ranging from 6% to 27.2%

in the least and most developed regions, respectively. Latin America and the Caribbean region

has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%),

Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend

analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from

6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases

occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia

(15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from

11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to

7.4%). Asia and Northern America were the regions with the highest and lowest average annual

rate of increase (6.4% and 1.6%, respectively).

Mylonas et al28 in their study reported that in Germany, the rate of Caesarean

Sections doubled from 15.3% in 1991 to 31.7% in 2012. The increase in Caesarean Sections

has been partly explained by increasing clinical indications for Caesarean Section such as

breech presentation, multiple pregnancy, fetal macrosomia, a history of previous Caesarean

Section, increasing maternal medical indications such as preeclampsia, maternal cardiac

conditions and the maternal request for elective Caesarean Section.

The World Health Organization (WHO) earlier predicted 5–15% rate of

caesarean section in any population to be acceptable29. Later in 2014, in their report, they

concluded that CS should be undertaken when medically necessary, and rather than striving to

achieve a specific rate, efforts should focus on providing caesarean section to all women in need.

13

How to define the woman ‘in need’ can only be ascertained by the health care providers caring

for the woman on a case‐by‐case basis30, 31.

The incidences of caesarean section are on a rise in India. The overall rate of caesarean

section delivery in 2015–16 is around 17.2% in India according to NFHS-4 data. It has increased

from 8.5% in 2005–06 reported in NFHS-3. (12, 13). However, the caesarean section rate is

estimated to be low in rural areas (12.9%) according to NFHS-4 data. Lack of availability of

emergency obstetric services, knowledge and financial constraints are some of the important

factors for low caesarean section rate among rural women.

12. International Institute for Population Sciences (IIPS) and Ministry of Health and Family Welfare. National Family Health Survey-4 (NFHS-4), India-Factsheet. http://rchiips.org/NFHS/pdf/NFHS4/India.pdf

13. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family

Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai.

COMPLICATIONS OF LSCS:

The most common complications after caesarean section in the mother are32-34:

1. Infection.

2. Heavy blood loss.

3. A blood clot in the legs or lungs.

4. Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the

abdominal procedure).

5. Bowel problems, such as constipation or when the intestines stop moving waste material

normally (ileus).

6. Injury to another organ (such as the bladder). This can occur during surgery.

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7. Maternal death (very rare).

In their study on the incidence of surgical complications associated with

caesarean section (CS) , Nielsen TF et al33 reported the overall complication rate was 11.6%

(9.5% patients with minor complications and 2.1% with major complications). The complication

rate for emergency operations was 18.9% and for elective CS, 4.2%--a highly significant

difference. (p less than 0.001).

Six risk factors were associated with the occurrence of surgical

complications in emergency cases:

1. Station of the presenting part of the fetus in relation to the spinal plane (p less than

0.001),

2. labor prior to surgery (p less than 0.001),

3. low gestational age (less than 32 weeks) (p less than 0.001),

4. rupture of fetal membranes (with labor) prior to surgery (p less than 0.01),

5. previous CS (p less than 0.01), and

6. skill of the operator (p less than 0.05).

However, no such risk factors were found in the elective group. They

concluded that emergency CS requires great skill on the part of the surgeon, and should therefore

not be entrusted to young, inexperienced obstetricians.

Post partum period is a challenging period where women start experiencing

motherhood and start adapting to new demands of the new born and her own . However,

pathology or complications at any stage in peri partum period may jeopardize the whole process.

Women experiencing delivery through Caesarean section are at higher risk of complications than

those through vaginal delivery.

15

As reported by Dimitrova V et al34, in 574 Planned or Elective Caesarean Section, the

frequency of postoperative complications was 1.4% while in 292 Emergency Caesarean section

it was 2.05% (p>0.05). There was not significant difference in the distribution of the different

types of postoperative complications in 34 cases with PCS and 33 cases with ECS. The

percentage of patients with previous CS was significantly higher in the complicated cases with

PCS compared to that with ECS. The two studied groups do not differ significantly regarding the

type of skin incision, operator's qualification, blood loss, drainage of the subfascial space,

accompanying diseases.

SURGICAL SITE INFECTION:

DEFINITION 35-37 :

The Centers for Disease Control and Prevention defines SSI as an

infection occurring within 30 days from the operative procedure in the part of the body where the

surgery took place.

The definition of a surgical site infection has been standardized by the Center for Disease

Control and Prevention. It can be grouped in incision, deep and organ infections.

Surgical site infections (SSI) are divided into two main groups:

(1) Incisional surgical site infections, which are further subdivided into

(1a) Superficial incisional (skin and subcutaneous tissues)

(1b) Deep incisional (deep soft tissue such as fascia and muscle layers)

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(2) Organ/space surgical site infections (any part of anatomy other than the incision opened or manipulated during an operative procedure)

According to the NHSN / CDC definition , Procedure associated Module , released on January

2018, the criteria are:

Superficial incisional surgical site infection criteria:

(1) Infection occurs at incision site within 30 days after surgery, where day 1 is the procedure date, and

(2) Infection involves only skin and subcutaneous tissue of the incision, and

(3) Patient has at least one of the following:

(3a) Purulent drainage from the superficial incision

(3b) Organism isolated from culture of fluid or tissue from the superficial incision, which is aseptically obtained

(3c) Surgeon deliberately opens wound and there is at least one sign or symptom (pain, tenderness, localized swelling, redness, heat), unless the wound culture is negative

(3d) Diagnosis of infection by surgeon or attending physician

(4) None of the following:

(4a) Stitch abscess with minimal inflammation and discharge confined to the points of suture penetration

(4b) Infection of an episiotomy site

(4c) Infection of a neonatal circumcision site

(4d) Infected burn wound

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Deep incisional surgical site infection criteria:

(1) Infection occurs at operative site

(1a) Within 30 days after surgery if no implant (nonhuman-derived foreign body that is permanently placed in the patient during surgery) is left in place,

(1b) Within 1 year after surgery if an implant is left in place

(2) Infection appears related to surgery, and

(3) Infection involves deep soft tissue (muscle and fascial layers), and

(4) At least one of the following:

(4a) Purulent drainage from the deep incision but not from the organ/space component of the surgical site

(4b) Wound dehisces or is deliberately opened by surgeon when patient has fever ( > 38°C) and/or localized pain and/or tenderness, unless the wound culture is negative

(4c) An abscess or other evidence of infection involving the deep incision seen on direct examination, during surgery, by histopathologic examination or by radiologic examination

(4d) Diagnosis of deep incisional surgical site infection by surgeon or attending physician

Organ/Space surgical site infection criteria:

(1) Infection occurs

(1a) within 30 days after surgery if no implant (nonhuman-derived foreign body that is permanently placed in the patient during surgery) is left in place,

(1b) within 1 year after surgery if an implant is left in place

(2) Infection appears related to surgery, and

(3) Infection involves any part of anatomy other than the incision opened or manipulated during an operative procedure, and

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(4) At least one of the following:

(4a) Purulent drainage from a drain that is placed through a stab wound into the organ/space

(4b) Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ or space

(4c) An abscess or other evidence of infection involving organ or space seen on direct examination, during surgery, by histopathologic examination, or on radiologic examination

(4d) Diagnosis of an organ/space surgical site infection by surgeon or attending physician

Specific sites of organ or space surgical site infection:

(1) Arterial Or Venous Infection

(2) Breast Abscess Or Mastitis

(3) Intervertebral Disc Space

(4) Ear, Mastoid

(5) Endometritis

(6) Endocarditis

(7) Eye, Other Than Conjunctiva

(8) Gastrointestinal Tract

(9) Intra-Abdominal, Not Specified Elsewhere

(10) Intracranial, Brain, Or Dural Infection Or Abscess

(11) Joint Or Bursa

(12) Mediastinitis

(13) Meningitis Or Ventriculitis

(14) Myocarditis Or Pericarditis

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(15) Oral Cavity (Mouth, Tongue Or Gums)

(16) Osteomyelitis

(17) Other Infections Of The Lower Respiratory Tract

(18) Other Infections Of The Urinary Tract

(19) other male or female reproductive tract

(20) spinal abscess without meningitis

(21) sinusitis

(22) upper respiratory tract, pharyngitis

(23) vaginal cuff

Classification when more than one site involved:

(1) Infection involving both superficial and deep surgical incisions is classified as a deep incisional surgical site infection

(2) If an organ or space infection drains through the incision, then it is classified as a deep incisional surgical site infection

Centers for Disease Control. Procedure- associated Module SSI. January 2015(Modified 2015). Available at:http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf.Accessed December 22, 2015.

There are two specific types of superficial incisional SSIs:

1. Superficial Incisional Primary (SIP) – a superficial incisional SSI that is identified in

the primary incision in a patient that has had an operation with one or more incisions (for

example, C-section incision or chest incision for CBGB)

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2. Superficial Incisional Secondary (SIS) – a superficial incisional SSI that is identified in

the secondary incision in a patient that has had an operation with more than one incision

(for example, donor site incision for CBGB)

Post operative infection at the surgical sites in the obstetrics and

gynaecological procedures are very common in developing countries as the state of health of

many women is below the optimum level, i.e hemoglobin, nutritional status and multiparity.

Wound infection is the commonest and most troublesome disorder of wound healing18, 38 and

despite modern surgical techniques and the use of antibiotics prophylaxis, surgical site infections

(SSI) remains a major contributory factor of maternal morbidity and mortality.

SSI is the second most common infectious complica tion after UTI following

caesarean delivery38. For the majority of obstetric patients, it rarely represents a threat to life.

However, there are far reaching morbidity and socioeconomic consequences for the health care

services.

Women undergoing Cesarean delivery have a 5 to 20 fold greater risk of

complication compared with Vaginal delivery 14.

Wound complications in caesarean section include Surgical site infection (stitch

abscess, cellulitis ) , seroma, haematoma, wound separation, wound dehiscence and rarely burst

abdomen15-18. Surgical site Infection predominates the picture. Infections are commonly

polymicrobial (caused by many organisms). Pathogens isolated from infected wounds and the

endometrium include Escherichia coli, group B streptococcus, Enterococcus faecalis, Staphylo-

21

coccus aureus and coagulase negative staphylococci, anaerobes (including Peptostreptococcus

species and Bacteroides species), Gardnerella vaginalis and genital mycoplasmas19.Antimicrobial

prophylaxis at the time of surgery has reduced the rate of postpartum endometritis and wound

infection after both nonelective and elective cesarean delivery20.

Wound complications delay the recovery, prolong the hospitalization,

necessitate the readmission or prolong outpatient treatment. Wound infection is the commonest

and most troublesome disorder of wound healing and despite modern surgical techniques and the

use of antibiotics prophylaxis. Surgical site infections are a major contributor to morbidity and

mortality in postsurgical care. Risk for surgical site infection is multifactorial and includes a host

of microbial, patient-related, and procedure-related factors4. Caesarean wound infections

represent a significant health and economic burden.

WOUNDS AND SURGICAL SITE INFECTION:

The term wound has been defined as a disruption of normal anatomical structure

and, more importantly, function.

Wound healing is divided into four sequential, yet overlapping phases:

(1) Hemostasis

(2) Inflammation,

(3) Proliferation And

(4) Remodeling39.

Complications in wound healing can arise from abnormalities in any of the basic

components of the repair process. Deficient scar formation, Hypertrophic scar, Keloid,

Exuberant granulation, Desmoids, Contractures, Avoidable scarring 40.

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The factors that influence repair can be categorized into local and systemic.

The classification system was developed initially by the American College of

Surgeons and adapted in 1985 by the Centers for Disease Control and Prevention.

Four classes of surgical wound types are described based on the wound’s level of

contamination:

I. Clean,

II. Clean- contaminated,

III. Contaminated and

IV. Dirty - infected

A biofilm 41, 42 can be described as a microbial colony encased in a polysaccharide

matrix which can become attached to a wound surface. This can affect the healing potential of

chronic wounds due to the production of destructive enzymes and toxins which can promote a

chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in

delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged

hospitalisation for some patients. There appears to be a correlation between biofilms and non-

healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of

wounds. They are a complex concept to diagnose and management needs to be multifactorial. In

many instances, wound colonising-bacteria are thought to be capable of forming biofilms, a

significant factor contributing to delays or failure in wound healing41. Antimicrobial prophylaxis,

has been shown to be effective at reducing risk of surgical site infection. Next to SSI, Hematoma

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represents the second-most common Cesarean wound complication.  In the short term, multiple

layers of closure serve as a barrier against infection. Wound hematomas develop when bleeding

occurs after the wound has been closed. Blood becomes trapped and exerts pressure on the

surrounding tissue, squeezing out nutrients and oxygen. If the pressure becomes great enough, it

can compromise the sutures, creating a portal for bacteria to enter the body, while the blood itself

provides a nutrient-rich growth medium for those bacteria. As with infection, treatment requires

exploration and drainage of the wound with a scalpel, and sometimes antibiotics

INCIDENCE OF POST CAESAREAN SSI:

In all the caesarean section patients, depending on the definitions used and the period

of observation, surgical site infection (SSI) occur in about 1.8%–9.8% of these subjects 6-13. The

rate of SSI has been reported to be from 5.7–9.0% 43 from studies around the world and many

other studies in various centres reported infection rates ranging from 6.09–38.7%6, 44. The total

number of Post CS SSI was 2.66% in the study by Dhar H et al (2014)22.

In England, 9.6% (394/4107) of women in the study developed a postsurgical

infection following caesarean section with 0.6% (23/4107) readmitted for treatment of the

infection7. The rate of SSI was 9.8% by Wilson J et al (2013)8. Furthermore, the mortality rate

associated with surgical site infection is 3% and 75% of SSI associated deaths are directly

caused by SSI45.

The variation in incidence may reflect differences in population

characteristics and risk factors, perioperative practices, and the duration from the procedure until

ascertainment. The risk for developing SSI has significantly decreased in the last three decades,

mainly owing to improvements in hygiene conditions, antibiotic prophylaxis, sterile procedures,

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and other practices. Despite this decrease, the occurrence of SSI is expected to increase given the

continuous rise in the incidence of cesarean deliveries. Post caesarean SSI may increase maternal

morbidity and mortality. In addition, SSI can be frustrating for the mother trying to recover from

the procedure and at the same time take care of the newborn. It may prolong maternal

hospitalization, increase health care costs, and lead to other socioeconomic implications.

Satyanarayan et al.46 in their study , reported rates of wound infections as high as

25.2% in emergency CS compared to 7.6% in elective cases.

Staphylococcus aureus is the most commonly isolated bacteria in wound

infections following Caesarean Section47. Other workers isolated more gram negative organisms

like E. coli, Proteus mirabilis, Pseudomonas and Klebsiella in CS wound infections. SSI in

relation to cesarean delivery has a distinctive microbial source of pathogens composed of both

skin and vaginal origin48. Accordingly, it is usually a polymicrobial infection consisting of both

aerobic bacteria and anaerobic organisms48. The variation in the spectrum of causative organisms

means that prophylactic antibiotic though effective may fail when the wrong agent is used or

used inappropriately

RISK FACTORS FOR POST CAESAREAN SSI:

Developing SSI is a traumatic experience. The multiple risk factors for

postcesarean wound and other infections include patient characteristics and intrapartum

management.

The risk factors for surgical site infections (SSI) after caesarean section are

many; these include intrinsic and extrinsic risk factors that predispose patients to SSI.

25

In trinsic factors are patient related while extrinsic factors are related to patient

care and management, although the intrinsic factors cannot be changed, the risk they present in

terms of infection is identifiable and manageable.

Risk factors6, 10, 14, 21, 22,7, 14, 21-24 can be divided into three categories49:

1) Host-related factors,

2) Pregnancy and Intrapartum-related factors, and

3) Procedure-related factors.

Host-related risk factors include maternal older or younger age, obesity, residence

in rural (compared to urban) area, pregestational diabetes mellitus, previous cesarean delivery,

recurrent pregnancy loss, and maternal preoperative condition (American Society of

Anesthesiologists score >3).

Pregnancy-related factors include hypertensive disorder, gestational diabetes

mellitus, twin pregnancy, preterm rupture of membranes, greater number of vaginal

examinations, prolonged trial of labor prior to surgery, epidural use, use of internal fetal

monitoring, and chorioamnionitis.

In regard to the procedure itself, SSI was more common among cesarean sections

performed in an emergency setting, non use of prophylactic antibiotics, and in cases

accompanied by uterine rupture, cesarean hysterectomy, need for blood transfusion and in

surgeries of longer duration. Surgery duration of more than 1 hour had been reported to increase

the risk for SSI more than twofold.

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SSI can be attributed to a perioperative bacterial load in the tissue at the site of

surgery and the diminished integrity of the host’s defenses. Some of the risk factors observed for

CS wound infections are obesity, diabetes, immunosuppressive disorders, chorioamnionitis, a

previous Caesarean delivery, certain medications like steroids, the lack of pre-incision

antimicrobial care, lengthy labour and surgery50. Any infection of the abdominal wound

complicating CS should be minimised through strict preventative measures, such as antisepsis,

preoperative preparation, a reduction in the duration of surgery, a reduction in blood loss, the use

of absorbable sutures and avoiding cross-infection.

Overall, factors 6, 10, 14, 21, 22,7, 14, 21-24that have been associated with an increased risk of

wound complications among women who have a cesarean delivery include

1. Emergency cesarean section21,

2. Labor and its duration,

3. Ruptured membranes and the duration of rupture,

4. The socioeconomic status of the woman,

5. Number of prenatal visits,

6. Vaginal examinations during labor,

7. Urinary tract infection,

8. Anemia,

9. Blood loss,

10. Obesity,

11. Diabetes,

12. The skill of the operator and

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13. The operative technique.

Schneid-Kofman N et al12 and Farret TC et al25 observed that

Emergency caesarean section is an independent risk factor for development of Surgical site

infection. Farret TC et al25 observed that patients who had an emergency cesarean had a 3.3-fold

greater risk of SSI.

Optimization of maternal comorbidities, appropriate antibiotic prophylaxis,

and good surgical technique may ameliorate the risk of subsequent wound infection. Clinical

suspicion for wound infection should be raised by fever, wound erythema, incisional drainage,

and expanding induration. Approaches to wound management combine administration of

topical/systemic antibiotics, debridement of necrotic tissue, and application of dressings for a

balanced moist environment20, 23. Necrotizing fasciitis represents a severe, rapidly expanding

wound infection, which presents an immediate threat to the life of the patient. Early

identification and debridement are critical for survival.

The variation in Surgical Site Infections is not only influenced by the use of antibiotic

prophylaxis but also importantly by specific obstetric risk factors. Zerr et al.51 have shown that

the risk of surgical site infection is increased in patients with medical conditions such as

diabetes mellitus and obesity.

Additionally, obesity is a recognized and well established health risk factor and has

an influence on wound healing and the risk of SSI12.

Intrapartum factors can also increase the risk of surgical site infection such as in

Caesarean Sections that are performed in labor or as an emergency and also where there is

suspected chorioamnionitis12.

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Not only are the patient dependent risk factors significant but also the surgical specific

factors may play a role in the risk of surgical site infection.

MOST RELEVANT STUDIES

1. SSI IN ELECTIVE Vs EMERGENCY CS 2. SSI INCIDENCE , RISK FACTORS:

SSI IN ELECTIVE Vs EMERGENCY CS

Vijaya K et al (2015)26 studied the incidence of wound infection in emergency and

elective lower segment cesarean section (LSCS) and factors predisposing to wound infection.

The differences in incidences of wound infection in emergency and elective LSCS was studied.

This Hospital based prospective and comparative study was conducted in Modern Government

Maternity Hospital, Petlaburj, Osmania Medical College, Hyderabad, from October 2012 to

September 2013. Total number of LSCS performed from November 2012 to October 2013 was

5864 (32.16% of the total deliveries - 18236).Total number of surgical site infections (SSI) in

254cases (4.33% of total LSCS performed) SSI in elective LSCS = 36 (1.03% of elective LSCS

performed) SSI in emergency LSCS = 218 (9.18% of emergency LSCS performed). Cases of SSI

with cesarean section performed elsewhere and referred to our hospital are excluded. The mean

age among cases of elective LSCS is 25 years. The mean age among cases of emergency LSCS

is 24 years. Anemia (26.77%) and preeclampsia (25.19%) are the most commonly associated

risk factors for SSI. The incidence of surgical site infection in cases of emergency LSCS is high,

increasing the maternal morbidity. The recognition and correction of associated medical

29

complications in the antenatal period is vital. Early decision making in cases of emergency

LSCS reduces the infection rate in cases of emergency LSCS. Gram negative E.coli and

Klebsiella are the most commonly isolated organisms and are sensitive to amino glycosides and

quinolone. Empirical treatment may be started against these organisms in case of delay in

culture and sensitivity report

Kishwar N et al (2016)52 in their study determined the risk factors for surgical site

infection in women undergoing lower segment caesarean section and compared the frequency of

identified risk factors for surgical site infection among women undergoing elective and

emergency caesarean section. They did a cross-sectional comparative study, conducted at

Hayatabad Medical Complex Peshawar from August 2014 to August 2015. Consecutive 195 post

operative cases of emergency and elective caesarean section with surgical site infection were

enrolled into the study. The patients were followed on the 3rd to 5th post-operative day and on

28th day thereafter. Final outcome i.e. surgical site infections (SSI) was measured on 28th day by

researcher and SSI were labeled as positive, as per operational definition. A total of 195 post-

operative cases diagnosed with surgical site infection, were studied during the specified period.

Of these 164(84.1%) were delivered with emergency caesarean section whereas 31(15.9%) by

elective caesarean section. Average age of the patients was recorded 27.8 ± 7.7 (ranging from 21

to 40) years, average parity of the women was recorded 4.4±1.6 (range 0-9), average gestational

age of the women was recorded 38±1.3 (ranging from 37 to 40) weeks. Average BMI of the

patients was recorded 29.3±4.6 (ranging from 20 to 45). In this study BMI of more than 35kg/m2

was associated with higher rate of SSI. Obesity, gestational age, educational and economic status

were risk factors for surgical site infections; more so following emergency vs elective caesarean

sections.

30

Dimitrova V et al (2005) 34 analyzed the frequency of complications after

elective/planned [PCS] and emergency Cesarean section [ECS]; 2) and compared the types of

complications in the two evaluated groups and the possible risk factors for complications after

elective and emergency procedures. The study was retrospective, hospital-based one. Data

regarding complications following Cesarean section [CS] that demanded transfer of the patients

to The Clinic of High Infectious Risk, State University Hospital "Maichin Dom", Sofia and

prolonged hospital stay (more than 7 days after the operation) were analyzed. The incidence of

complications in 574 consecutive PCS and in 292 ECS was calculated. The type of the following

complications was compared in the two groups: uterine infections (endo/mio/ metrophlebitis),

wound infection, subfascial hematoma, residua, sepsis, pelvic thrombophlebitis. Statistical

evaluation of the results was performed by Student's t-test with p<0.05 considered statistically

significant. In 574 PCS the frequency of postoperative complications was 1,4% while in 292

ECS it was 2,05% (p>0.05). There was not significant difference in the distribution of the

different types of postoperative complications in 34 cases with PCS and 33 cases with ECS. The

percentage of patients with previous CS was significantly higher in the complicated cases with

PCS compared to that with ECS. The two studied groups do not differ significantly regarding the

type of skin incision, operator's qualification, blood loss, drainage of the subfascial space,

accompanying diseases. They concluded that Cesarean section constitutes a major surgical

procedure characterised with morbidity even if performed as a planned procedure. The risk of

complications seems to be higher in cases of repeated CS.

31

SSI INCIDENCE , RISK FACTORS:

Farret TC et al (2015)25 evaluated patients with diagnosis of surgical site infection

(SSI) following cesarean section and their controls to determinate risk factors and impact of

antibiotic prophylaxis on this condition. All cesareans performed from January 2009 to

December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control

patients were determined after inclusion of case patients. Medical records of case and control

patients were reviewed and compared regarding sociodemographic and clinical characteristics.

Their study demonstrated an association following univariate analysis between post-cesarean SSI

and number of internal vaginal examinations, time of membrane rupture, emergency cesarean

and improper use of antibiotic prophylaxis. This same situation did not repeat itself in

multivariate analysis with adjustment for risk factors, especially with regard to antibiotic

prophylaxis, considering the emergency cesarean factor only. They not only questioned surgical

antimicrobial prophylaxis use based on data presented here and in literature, but suggested that

the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean

section. Further research with greater number of patients and evaluated risk factors are

fundamental for better understanding of the causes and evolution of surgical site infection after

cesarean delivery.

Nuthalapaty FS et al (2013)53 compared wound complications after Caesarean

section in the obese patient, following early versus delayed skin staple removal. They conducted

a single-centre, non-inferiority, randomized controlled trial. Following Caesarean section, obese

women (BMI ≥ 30 kg/m(2)) with subcutaneous wound depth ≥ 2.0 cm and skin staple closure of

a transverse incision were randomized to staple removal on postoperative day 3 (early) or

32

between postoperative day 7 and postoperative day 10 (delayed). The primary outcome was

superficial wound dehiscence; a rate of 8% or higher in the early group was defined as inferior.

Secondary outcomes were seroma/hematoma, surgical site infection, and visual analogue pain

score. The planned sample size was 250 patients per group. The study was halted after 295

patients were randomized because of slow enrolment and exhaustion of funding. The rate of

superficial wound dehiscence was 15.2% in the early group (n = 145) versus 11.5% in the

delayed group (n = 148). The point estimate for this difference (3.7 %; 95% CI -4.4 to 12.4)

favours delayed removal. However, because the 95% CI includes zero and the upper CI exceeds

the predefined limit for non-inferiority (8%), non-inferiority was not demonstrated. The rates of

all secondary outcomes were similar in the early group and the delayed group: seroma/hematoma

(6.9% vs. 4.7%; RR 1.4, 95% CI 0.6 to 3.7, P = 0.4); surgical site infection (9.7% vs. 4.8%; RR

2.0, 95% CI 0.8 to 4.9, P = 0.1); and composite (superficial wound dehiscence,

seroma/hematoma, and surgical site infection) wound complication (17.2% vs. 12.8%; RR 1.3,

95% CI 0.8 to 2.3, P = 0.3). They concluded that the non-inferiority of early skin staple removal

was not demonstrated. Delayed removal of staples should remain the accepted standard in the

obese patient following Caesarean section.

Moreira CM et al (2014) 54 evaluated the safety of electrocautery for coagulation

during Caesarean sections. A randomized, controlled, clinical pilot study was performed at a

university maternity hospital. After admission for delivery and decision to perform a C-section,

volunteers were randomized to either the intervention group (use of electrocautery for

coagulation) or nonintervention group. The women were examined at the time of postpartum

discharge (day 3), at days 7 to 10, and again at days 30 to 40 for signs of infection, hematoma,

seroma, or dehiscence. Data were analyzed using an intention-to-treat analysis, and risk ratios

33

were calculated. No significant differences were found between the two groups. Only 2.8% of

patients in the intervention group developed surgical wound complications during

hospitalization. However, 7 to 10 days following discharge, these rates reached 23.0% and

15.4% in the intervention and nonintervention groups, respectively (RR = 1.50, 95% CI = 0.84-

2.60). They concluded that further studies should confirm whether the use of electrocautery for

coagulation does not increase the risk of surgical wound complications in patients undergoing

Caesarean sections.

Corcoran S et al (2013)55 undertook a baseline assessment to determine SSI rates, and

subsequently a quality improvement program was introduced, followed by repeat surveillance.

Data were collected during in-hospital stays and for up to 30 days after CS during both periods.

Interventions in the quality improvement program included the use of nonabsorbable sutures for

skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection

before incision. A total of 710 patients were surveyed before the interventions, and 824 patients

were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions,

and 40 (4.9%) had an SSI after the interventions (P < .001; odds ratio, 0.27), with 90% and 83%,

respectively, detected after hospital discharge. In multivariate analysis, obesity (P = .002) and the

use of absorbable suture materials for skin closure (P = .008) were significantly associated with a

higher SSI rate before the interventions; however, only obesity was associated with a higher SSI

rate after the quality program. They concluded that surveillance of SSI rates after CS followed by

3 interventions contributed to a significant reduction in SSI rate and improved patient care.

34

Gong SP et al (2012)50 estimated the incidence and identified the risk factors for a

surgical site infection after a cesarean section. A survey of women who underwent a cesarean

section was conducted in eight hospitals in Guangdong Province, China. The rate of surgical site

infection was estimated and a nested case control study was then carried out to identify the risk

factors. Among 13 798 women surveyed, 96 (0.7%) developed a surgical site infection after a

cesarean section. Multivariate logistic regression analysis identified six factors independently

associated with an increased risk of surgical site infection, which included obesity, premature

rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic

antibiotics and excessive anal examinations performed during hospitalization. They concluded

that Surgical site infection occurs in approximately 0.7% of cesarean section cases in the general

obstetric population in China. Obesity, premature rupture of membranes, lower preoperative

hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations

during hospitalization are considered to be independent risk factors.

Dhar H et al (2014)22 determined the incidence of surgical site infections (SSI) in

patients undergoing a Caesarean section (CS) and identified risk factors, common bacterial

pathogens and antibiotic sensitivity. SSI significantly affect the patient's quality of life by

increasing morbidity and extending hospital stays. A retrospective cross-sectional study was

conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS) SSI

from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI.

Controls (220) were randomly selected cases, at the same hospital in the same time period, who

had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic

profile, type of organism, drug sensitivity and date of infection. RESULTS: The total number of

35

PCS wound infections was 211 (2.66%). There was a four-fold higher incidence of premature

rupture of the membranes (37, 17.53%) and a three-fold higher incidence of diabetes (32,

15.16%) in the PCS cases compared with controls. The most common organisms responsible for

SSI were Staphylococcus aureus (66, 31.27%) and the Gram-negative Escherichia coli group

(40, 18.95%). The most sensitive antibiotics were aminoglycoside and cephalosporin.

Polymicrobial infections were noted in 42 (19.90%), while 47 (22.27%) yielded no growth. A

high incidence of associated risk factors like obesity, hypertension, anaemia and wound

haematoma was noted. They concluded Measures are needed to reduce the incidence of SSI,

including the implementation of infection prevention practices and the administration of

antibiotic prophylaxis with rigorous surgical techniques.

Jenks PJ et al (2014)13 determined the clinical and economic burden of SSI over a

two-year period and predicted the financial consequences of their elimination. SSI surveillance

and Patient Level Information and Costing System (PLICS) datasets for patients who underwent

major surgical procedures at Plymouth Hospitals NHS Trust between April 2010 and March

2012 were consolidated. The main outcome measures were the attributable postoperative length

of stay (LOS), cost, and impact on the margin differential (profitability) of SSI. A secondary

outcome was the predicted financial consequence of eliminating all SSIs. The median additional

LOS attributable to SSI was 10 days [95% confidence interval (CI): 7-13 days] and a total of

4694 bed-days were lost over the two-year period. The median additional cost attributable to SSI

was pound5,239 (95% CI: 4,622-6,719) and the aggregate extra cost over the study period was

pound2,491,424. After calculating the opportunity cost of eliminating all SSIs that had occurred

in the two-year period, the combined overall predicted financial benefit of doing so would have

been only pound694,007. For seven surgical categories, the hospital would have been financially

36

worse off if it had successfully eliminated all SSIs. They concluded that SSI causes significant

clinical and economic burden. Nevertheless the current system of reimbursement provided a

financial disincentive to their reduction.

Dyrkorn OA et al (2012)44 did their interventional study to reduce the caesarean

section surgical wound infection incidence to below the Norwegian national level of 8 %. The

intervention (a quality improvement project) was implemented in September 2008. A bundle of

measures were introduced. Staff from all aspects of patient flow was recruited. Cochrane

literature was used as gold standard. Data registration was based upon CDC criteria. RESULTS:

were based on data collected through the Norwegian national surveillance system for infections

in health care, NOIS. Study setting This Maternity clinic has about 2500 births annually and a

caesarean section rate pushing 15 %. The study was conducted on caesarean section patients

registered in NOIS (2008-2010). From September 2009 data were harvested continuously. Data

were monitored as cumulative incidence rate and by statistical process control as g chart (number

of surgeries between infections including a delayed moving average). Infection control staff

reported results to Head of Maternity Clinic monthly. The overall rate of caesarean section

surgical wound infections was significantly reduced to 3,1 % (2008-2010 about 1 % in 2010).

This result was demonstrated elegantly as a marked shift in process in g-chart. We found the g-

chart was efficient, sensitive and simple to handle.

Gregson H (2011)43 did their study to set up a surgical site infection (SSI) benchmark

rate for caesarean sections and improve infection rates by monitoring and implementing

compliance with the guidelines produced by the National Institute for Health and Clinical

37

Excellence (NICE). A total of 2382 patients who had undergone caesarean section at Maidstone

and Tunbridge Wells NHS Trust were monitored at two obstetric sites over a two-year period. A

proactive infection surveillance system was used during the patients' hospital stay. Community

midwives collected and returned post-discharge data on wound status. Patients were asked to

return post-operative questionnaires 30 days after surgery, providing details of any wound

problems. Compliance with NICE guidance on reducing SSIs was measured at both sites and

changes were implemented accordingly. Infection rates before compliance with NICE guidance

from July 2008 to June 2009 ranged from 5.7% to 9.0%. After introducing the guidelines, rates

of SSI at site A and site B were reduced by 3.3% and 3.8% respectively. Rates of SSI at site A

were reduced further to 1.3% on introduction of the hydrofiber and hydrocolloid dressing.

Results suggest that the hydrofiber and hydrocolloid combination dressing assists in the

reduction of SSI rates following caesarean section when used in combination with the NICE

guidance.

Wilson J et al (2013)8 evaluated the efficacy of case-finding methods for SSI

following caesarean delivery and their utility in establishing benchmark rates of SSI. Hospitals

conducted surveillance over one or two 13-week periods. Patients were reviewed during their

inpatient stay, post partum by community midwives and via patient questionnaire at 30 days post

delivery. To estimate the reliability of case-finding methods, case-note reviews were undertaken

in a random sample of four hospitals. A total of 404 SSIs were detected in 4107 caesarean

deliveries from 14 hospitals. The median time to SSI was 10 days, 66% were detected in-hospital

or by community midwives, and an additional 34% were patient-reported. The rate of SSI was

9.8% but the proportion of patients followed up varied significantly between centres. The

estimated sensitivity and specificity of case-finding was 91.4% [95% confidence interval (CI):

38

53.4-98.4] and 98.6% (95% CI: 98.4-98.8), the positive predictive value 91.0% (95% CI: 82.4-

96.1) and negative predictive value 98.6% (95% CI: 93.9-99.5). Combined case ascertainment

methods are a feasible way to achieve active post-discharge surveillance and had high negative

and positive predictive values. Additional SSIs can be detected by patient questionnaires but

rates of SSI were strongly influenced by variation in intensity of both healthcare worker- and

patient-based case-finding. This factor must be taken into account when comparing or

benchmarking rates of SSI.

Wloch C et al (2012)7 assessed the frequency and risk factors for surgical site

infection following caesarean section. In their Prospective multicentre cohort study, data from

fourteen NHS hospitals in England, April to September 2009 were studied. Women who

underwent caesarean section at participating hospitals during designated study periods.:

Infections that met standard case definitions were identified through active follow up by

healthcare staff during the hospital stay, on return to hospital, during midwife home visits and

through self-completed patient questionnaires. MAIN OUTCOME MEASURE: Surgical site

infection within 30 days of operation. Altogether, 9.6% (394/4107) of women in the study

developed a postsurgical infection following caesarean section with 0.6% (23/4107) readmitted

for treatment of the infection. Being overweight (body mass index [BMI] 25-30 kg/m(2) odds

ratio [OR] 1.6, 95% confidence interval [95% CI] 1.2-2.2) or obese (BMI 30-35 kg/m(2) OR 2.4,

95% CI 1.7-3.4; BMI > 35 kg/m(2) OR 3.7, 95% CI 2.6-5.2) were major independent risk factors

for infection (compared with BMI 18.5-25 kg/m(2)). There was a suggestion that younger

women, and operations performed by associate specialist and staff grade surgeons had a greater

odds of developing surgical site infection with OR 1.9, 95% CI 1.1-3.4 (<20 years versus 25-30

years), and OR 1.6, 95% CI 1.0-2.4 (versus consultants), respectively. This study identified high

39

rates of postsurgical infection following caesarean section. Given the number of women

delivering by caesarean section in the UK, substantial costs will be incurred as a result of these

infections. Prevention of these infections should be a clinical and public health priority.

Hadar E et al (2011) 10 investigated the timing and risk factors of maternal

complications of cesarean section (CS). Review of the files of all women who underwent CS at a

tertiary medical center between September 2007 and December 2008 yielded 100 patients with

postpartum complications was done . Their clinical and surgery-related characteristics were

compared with 100 women with uncomplicated CS operated in January 2009. Complications

were analyzed by prevalence and time of occurrence. The only between-group difference in

background factors was a higher rate of obesity (BMI > 30) in the controls. The complication

rate was 5.7%. The most common complication was endomyometritis (3.6%), followed by

wound infection (1.8%) and wound hematoma (1.2%). In most cases, endomyometritis was

diagnosed on postoperative days 2-3 and wound complications on days 2-5; 7 of the 9

readmissions occurred on postoperative days 5-6. On multivariate analysis, significant

independent predictors of postoperative complications were surgeon experience (OR = 2.4, 95%

CI 1.2-4.8) and intra-partum CS (OR = 2.1, 95% CI 1.1-4.3). Cesarean section performed by a

resident or during active labor is associated with an increased risk of postpartum complications.

Medical teams should be alert to morbidity in women at risk, particularly during the first 4 days

after CS.

Alanis MC et al (2010)9 in their study determined predictors of cesarean delivery

morbidity associated with massive obesity. This was an institutional review board-approved

40

retrospective study of massively obese women (body mass index, > or = 50 kg/m(2)) undergoing

cesarean delivery. Bivariable and multivariable analyses were used to assess the strength of

association between wound complication and various predictors. Fifty-eight of 194 patients

(30%) had a wound complication. Most (90%) were wound disruptions, and 86% were

diagnosed after hospital discharge (median postoperative day, 8.5; interquartile range, 6-12).

Subcutaneous drains and smoking, but not labor or ruptured membranes, were independently

associated with wound complication after controlling for various confounders. Vertical

abdominal incisions were associated with increased operative time, blood loss, and vertical

hysterotomy. Women with a body mass index > or = 50 kg/m(2) have a much greater risk for

cesarean wound complications than previously reported. Avoidance of subcutaneous drains and

increased use of transverse abdominal wall incisions should be considered in massively obese

parturients to reduce operative morbidity.

Olsen MA et al (2008)6 determined independent risk factors for SSI after low

transverse cesarean section. They did their Retrospective case-control study in Barnes-Jewish

Hospital, a 1,250-bed tertiary care hospital. A total of 1,605 women who underwent low

transverse cesarean section during the period from July 1999 to June 2001. Using the

International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes

for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or

at readmission to the hospital or emergency department, we identified potential cases of SSI in a

cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified

by chart review using the definitions from the Centers for Disease Control and Prevention's

National Nosocomial Infections Surveillance System. Control patients without SSI or

endomyometritis were randomly selected from the population of patients who underwent

41

cesarean section. Independent risk factors for SSI were determined by logistic regression. SSIs

were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section.

Independent risk factors for SSI included development of subcutaneous hematoma after the

procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval [CI], 4.1-33.2]), operation

performed by the university teaching service (aOR, 2.7 [95% CI, 1.4-5.2]), and a higher body

mass index at admission (aOR, 1.1 [95% CI, 1.0-1.1]). Cephalosporin therapy before or after the

operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1-0.5]). Use

of staples for skin closure was associated with a marginally increased risk of SSI. They

concluded that these independent risk factors should be incorporated into approaches for the

prevention and surveillance of SSI after surgery.

Opoien HK et al (2007)11 , in their study documented the true incidence of post-cesarean

surgical site infections (SSI), according to the definition of the US Centers for Disease Control

and Prevention (CDC), and to identify independent risk factors for infection. They did a

Prospective population-based cohort study in Norway in Sykehuset Asker og Baerum HF, a

secondary community hospital, associated with the University of Oslo (UiO), Norway,

accounting for 2,000 deliveries per year. All cesarean deliveries during a 12-month period from

September 2003 were participants. Their main outcome measures were rate and risk factors for

SSI. The total rate of SSI was 8.9%, with an observation period of 30 days post-operatively,

compared to 1.8% registered at hospital discharge. The total response rate was 100%. There was

no significant difference in SSI rate in elective or emergency cesarean section (CS), respectively.

All SSI were superficial. We found 2 significant independent risk factors: operating time > or

=38 min and body mass index (BMI) >30. They concluded that the rate of SSI is underestimated

42

if the observation time is limited to the hospital stay. Operating time exceeding 38 min

substantially increases the risk of SSI. The finding of no significant difference in SSI rate

between elective and emergency CS should lead to a different approach concerning the use of

antibiotics: subgroup at risk (operating time > or =38 min and BMI >30) may benefit from

antibiotics in relation to the operation, whether the CS is an emergency or elective operation.

Schneid-Kofman N et al (2005)12 in their study identified risk factors for early

wound infection (diagnosed prior to discharge) following cesarean delivery. They did a

population-based study comparing women who have and have not developed a wound infection

prior to discharge from Soroka University Medical Center, Ben Gurion University of the Negev,

between 1988 and 2002. Of the 19,416 cesarean deliveries performed during the study period,

726 (3.7%) were followed by wound infection. Using a multivariable logistic regression model,

the following risk factors were identified: obesity (odds ratio [OR] = 2.2; 95% confidence

interval [CI], 1.6-3.1); hypertensive disorders (OR = 1.7; 95% CI, 1.4-2.1); premature rupture of

membranes (OR = 1.5; 95% CI, 1.2-1.9); diabetes mellitus (OR = 1.4; 95% CI, 1.1-1.7);

emergency cesarean delivery (OR = 1.3; 95% CI, 1.1-1.5); and twin delivery (OR = 1.6; 95% CI,

1.3-2.0). Combined obesity and diabetes (gestational and pregestational) increased the risk for

wound infection 9.3-fold (95% CI, 4.5-19.2; P < .001). They concluded that independent risk

factors for an early wound infection were obesity, diabetes, hypertension, premature rupture of

membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates

of wound infection should be provided to obese women undergoing cesarean delivery, especially

when diabetes coexists.

43

Nielsen TF et al (1984)33 studied the incidence of surgical complications associated with

cesarean section (CS) prospectively in 1319 patients undergoing CS during the years 1978, 1979

and 1980 (18% of all deliveries). The overall complication rate was 11.6% (9.5% patients with

minor complications and 2.1% with major complications). The complication rate for emergency

operations was 18.9% and for elective CS, 4.2%--a highly significant difference. (p less than

0.001). Six risk factors were associated with the occurrence of surgical complications in

emergency cases: Station of the presenting part of the fetus in relation to the spinal plane (p less

than 0.001), labor prior to surgery (p less than 0.001), low gestational age (less than 32 weeks) (p

less than 0.001), rupture of fetal membranes (with labor) prior to surgery (p less than 0.01),

previous CS (p less than 0.01), and skill of the operator (p less than 0.05). However, no such risk

factors were found in the elective group. The clinical relevance of these findings is summarized

in two conclusions. Firstly, the proportion of emergency operations needs to be reduced, either in

favor of elective procedures, or by allowing more patients to give birth by the vaginal route.

Secondly, emergency CS requires great skill on the part of the surgeon, and should therefore not

be entrusted to young, inexperienced obstetricians.

44

45

46

MATERIALS & METHODS

47

Study site: This study was conducted in the Department of…………………………….

Study population: All the eligible patients ……………. department at …………………

were considered as study population

Study design: The current study was a ………………….. study

Sample size:

Sampling method: All the eligible subjects were recruited into the study consecutively by

convenient sampling till the sample size is reached.

Study duration: The data collection for the study was done between October 2016 to October

2017 for a period of 1 year.

Inclusion Criteria

Exclusion criteria:

Ethical considerations: Study was approved by institutional human ethics committee. Informed

written consent was obtained from all the study participants and only those participants willing to

sign the informed consent were included in the study. The risks and benefits involved in the

study and voluntary nature of participation were explained to the participants before obtaining

consent. Confidentiality of the study participants was maintained.

Data collection tools: All the relevant parameters were documented in a structured study proforma.

Methodology:

Statistical Methods:

48

OBSERVATIONS AND RESULTS

49

50

RESULTS:

51

DISCUSSION

DISCUSSION:

52

BIBLIOGRAPHY

REFERENCE:

53

54

1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.

56

27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.

57

49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).53. Nuthalapaty FS, Lee CM, Lee JH, Kuper SG, Higdon HL, 3rd. A randomized controlled trial of early versus delayed skin staple removal following caesarean section in the obese patient. J Obstet Gynaecol Can. 2013;35(5):426-33.54. Moreira CM, Amaral E. Use of electrocautery for coagulation and wound complications in Caesarean sections. ScientificWorldJournal. 2014;2014:602375.55. Corcoran S, Jackson V, Coulter-Smith S, Loughrey J, McKenna P, Cafferkey M. Surgical site infection after cesarean section: implementing 3 changes to improve the quality of patient care. Am J Infect Control. 2013;41(12):1258-63.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

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15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.

59

36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).53. Nuthalapaty FS, Lee CM, Lee JH, Kuper SG, Higdon HL, 3rd. A randomized controlled trial of early versus delayed skin staple removal following caesarean section in the obese patient. J Obstet Gynaecol Can. 2013;35(5):426-33.54. Moreira CM, Amaral E. Use of electrocautery for coagulation and wound complications in Caesarean sections. ScientificWorldJournal. 2014;2014:602375.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.

60

4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

61

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.

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47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).53. Moreira CM, Amaral E. Use of electrocautery for coagulation and wound complications in Caesarean sections. ScientificWorldJournal. 2014;2014:602375.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

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15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.

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36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

65

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

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26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.

67

48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

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17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.

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38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

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8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

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29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.

72

52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.

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21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.

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43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.

75

12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.

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34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

77

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

78

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.

79

47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).

80

16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.

81

37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.

83

27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.

84

49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.

85

18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.

86

39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.

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9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.

88

31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).

89

1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.

90

22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.

91

44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.

92

13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.

93

35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

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6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

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26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.

96

48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

97

17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.

98

38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

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8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

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29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.

101

52. Kishwar N, Hayat N, Ayoub S, Ali S. Surgical site infections among patients undergoing elective versus emergency caesarean section. J Postgrad Med Inst. 2016;30(4).1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.

102

21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.

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43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.

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13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.

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35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

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6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

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26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.

108

48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.

109

18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.

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39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.51. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63(2):356-61.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

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10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.

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31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

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3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.

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24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.

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46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Gilstrap LC, 3rd, Cunningham FG. The bacterial pathogenesis of infection following cesarean section. Obstet Gynecol. 1979;53(5):545-9.49. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.50. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

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17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.

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38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Ako-Nai AK, Adejuyigbe O, Adewumi TO, Lawal OO. Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital. East Afr Med J. 1992;69(9):500-7.48. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.49. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

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11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.

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32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.

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27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.

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2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.

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23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.

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45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.

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18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.

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39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.

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14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.

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36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

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10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.

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31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

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6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

132

26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.

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1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.

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22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.

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44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.48. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

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17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.

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38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.

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13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.

139

35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7.46. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.47. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

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10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.

141

31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

142

7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.

143

27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

144

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.

145

24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.

146

46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.

147

21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.

148

43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.

149

18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.

150

39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

151

15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.

152

36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.44. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.45. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

153

11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.

154

32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.44. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.45. Dyrkorn OA, Kristoffersen M, Walberg M. Reducing post-caesarean surgical wound infection rate: an improvement project in a Norwegian maternity clinic. BMJ Qual Saf. 2012;21(3):206-10.46. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

155

8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

156

29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.44. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.45. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

157

7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.

158

27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.44. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011;25(50):35-40.45. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

159

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

160

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Satyanarayana V, Prashanth H, Basavaraj B, Kavyashree A. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5(October (5)):935-9.44. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

161

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.

162

24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.43. Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 2012;38(3):509-15.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

163

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.

164

24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.

165

4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

166

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

167

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

168

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

169

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

170

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.38. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.39. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.40. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.41. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.42. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

171

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

172

25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.37. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.38. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.39. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.40. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.41. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

173

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

174

26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.36. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.37. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.38. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.39. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.40. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

175

8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

176

29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.36. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.37. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.38. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.39. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.

177

12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.

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34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.36. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.37. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.38. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.39. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

179

17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.36. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.37. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.38. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.39. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.

180

1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.

181

22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care. 2008;23(3):308-16.36. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.37. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.38. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.39. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

182

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

183

26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.36. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.37. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.38. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

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10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.

185

31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.36. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.37. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.38. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

186

15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Dimitrova V, Pandeva I, Tsankova M, Pranchev N. [Post-operative complications following elective and emergency caesarean delivery]. Akush Ginekol (Sofiia). 2005;44(7):15-21.35. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.36. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.

187

37. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.38. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.

188

20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.35. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.36. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.37. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

189

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

190

26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Fawzy M, Zalata K. Late post-cesarean surgical complication. J Obstet Gynaecol Res. 2010;36(3):544-9.33. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.34. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.35. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.36. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.37. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

191

11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.

192

32. Nielsen TF, Hokegard KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand. 1984;63(2):103-8.33. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.34. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.35. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.36. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.

193

18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.33. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.34. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.35. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

194

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.

195

26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.33. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.34. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.35. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.

196

13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.32. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.33. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.34. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.

197

35. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.

198

21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO Statement on Caesarean Section Rates. Bjog. 2016;123(5):667-70.31. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.32. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.33. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.34. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.

199

9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.30. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.

200

31. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.32. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.33. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.

201

19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.30. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book: elsevier health sciences; 2014.31. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.32. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

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8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

203

29. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26s-38s.30. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.31. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.

204

19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.29. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.30. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

205

10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.28. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.29. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

206

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.

207

24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.28. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.

208

17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462-73.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.22. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.23. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.24. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.25. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.26. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.27. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.28. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

209

11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994;37(4):842-55.18. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.19. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.20. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.21. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.22. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.23. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.24. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.25. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.26. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.27. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

210

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Parrott T, Evans AJ, Lowes A, Dennis KJ. Infection following caesarean section. J Hosp Infect. 1989;13(4):349-54.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.20. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.21. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.22. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.23. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.24. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.25. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.26. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.

211

1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Chandrasiri M, Fernandopullae R. Comparison of surgical site infections and patients’ comfort level with caesarean section wounds following early exposure versus delayed exposure. Sri Lanka Journal of Obstetrics and Gynaecology. 2016;38(1).16. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.17. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.18. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.19. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.20. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.21. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.

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22. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.23. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.24. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.25. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.16. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.17. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.

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18. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.19. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.20. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.21. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.22. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.23. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.24. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

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15. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.16. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.17. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.18. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.19. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.20. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.21. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.22. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.23. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.24. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.

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12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.16. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.17. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.18. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.19. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.20. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.21. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.22. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.23. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.24. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.

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10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.19. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.20. Vijaya K, Padmaja A, Poreddy A, Vivekanand N. Surgical Site Wound Infection in Emergency and Elective LSCS–A Comparative Study. Sch J App Med Sci. 2015;3(9D):3412-7.21. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.22. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.23. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.24. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

217

8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Jido TA, Garba ID. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2012;2(1):33-6.19. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.20. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.21. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.22. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.23. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.22. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

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6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.22. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

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5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.22. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.

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4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017;9:81-8.18. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.19. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.20. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.21. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.22. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

222

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.18. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.19. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.20. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.21. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

223

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.18. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.19. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.20. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.21. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

224

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Farret TC, Dalle J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015;19(2):113-7.18. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.19. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.20. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.21. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.

225

3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.20. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.

226

5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.20. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.

227

6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.20. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

228

7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.20. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.

229

8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014;14(2):e211-7.17. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.18. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.19. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.20. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.

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9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.17. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.18. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.19. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

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11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34(4):398-402.16. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.17. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.18. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.19. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama. 2015;314(21):2263-70.3. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.4. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.5. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.6. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.7. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.8. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.9. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.10. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.11. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.12. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.

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13. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.14. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.15. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.16. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.17. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.18. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Miller ES, Hahn K, Grobman WA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121(4):789-97.2. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.3. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.4. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.5. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.6. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.7. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.8. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.9. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.10. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.11. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.12. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.13. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.14. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.15. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.16. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.

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17. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.3. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.4. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.5. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.6. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.7. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.8. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.9. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.10. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.11. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.12. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.13. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.14. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.15. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.16. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.3. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.4. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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5. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.6. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.7. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.8. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.9. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.10. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.11. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.12. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.13. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.14. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.15. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.16. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.3. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.4. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.5. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.6. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.7. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.8. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.

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9. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.10. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.11. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.12. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.13. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.14. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.15. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.16. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94(6):1245-64.3. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.4. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.5. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.6. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.7. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.8. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.9. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.10. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.11. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.12. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.13. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.

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14. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.15. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.16. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.3. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.4. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.5. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.6. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.7. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.8. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.9. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.10. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.11. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.12. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.13. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.14. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.15. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.

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3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.7. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.8. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.9. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.10. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.11. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.12. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.13. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.14. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.15. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.7. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.

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8. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.9. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.10. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.11. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.12. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.13. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.14. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.15. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.7. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.8. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.9. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.10. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.11. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.12. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.13. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.14. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.

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1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.7. Opoien HK, Valbo A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.8. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.9. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.10. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.11. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.12. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.13. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283(4):735-41.7. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

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8. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.9. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.10. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.11. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.12. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010;203(3):271.e1-7.6. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.7. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.8. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.9. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.10. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.11. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, et al. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.5. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.

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6. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.7. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.8. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.9. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.10. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. Bjog. 2012;119(11):1324-33.4. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.5. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.6. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.7. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.8. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.9. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.2. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84; discussion 85-6.3. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(5 Suppl):178s-84s.4. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40(3):171-5.5. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000(2):Cd001136.6. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014;41(4):671-89.7. Rajpaul K. Biofilm in wound care. Br J Community Nurs. 2015;Suppl Wound Care:S6, s8, s10-1.8. Alavi MR, Stojadinovic A, Izadjoo MJ. An overview of biofilm and its detection in clinical samples. J Wound Care. 2012;21(8):376-83.

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