Necrotizing fasciitis – a rare complication following common obstetric operative procedures

Necrotizing fasciitis, an almost fatal soft-tissue infection complicating obstetric operative wounds, is an uncommon entity in obstetrics. Herein, two cases of necrotizing fasciitis in severely undernourished and anemic women following obstetric operative procedures are reported. Both undernourishment and anemia compounded the already existing immune-suppressed state in pregnancy and may have resulted in life-threatening necrotizing fasciitis. One of the patients developed necrotizing fasciitis following episiotomy and the other following cesarean section. Both the cases were diagnosed clinically. Management was done by total parenteral nutrition, prompt correction of anemia, and surgical debridement under broad-spectrum antibiotic coverage. The raw areas were later reconstructed by split skin grafting in the first case, whereas, in the second case, due to the patient’s refusal of skin grafting, the wound was allowed to heal by secondary intention. Both patients survived, although with morbidity. The study seeks to emphasize prompt correction of comorbidities along with aggressive management of necrotizing fasciitis for superior outcomes in the obstetric population. Early correction of nutritional status improves the rate of survival.

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