BMC Pregnancy Childbirth. 2025 Dec 23. doi: 10.1186/s12884-025-08577-x. Online ahead of print.
ABSTRACT
BACKGROUND: Caesarean section (CS) is among the most frequently performed surgical procedures worldwide and is critical for reducing maternal and neonatal mortality. However, surgical site infections (SSIs) remain one of the most common postoperative complications, imposing substantial maternal morbidity, delaying recovery, and indirectly affecting neonatal health. Despite various infection prevention measures, the burden of SSIs is particularly high in low- and middle-income countries (LMICs). Emerging evidence suggests that implementing evidence-based care bundles can markedly reduce SSIs, but existing studies are fragmented and inconsistent, underscoring the need for a comprehensive synthesis.
OBJECTIVE: To evaluate the effectiveness of evidence-based care bundles in preventing SSIs following caesarean delivery.
METHODS: This systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO registration: CRD42024603854). A comprehensive search was conducted in PubMed, Cochrane Library, Scopus, Hinari, and Google Scholar using a PICO-based strategy. Eligible studies were critically appraised using the revised Joanna Briggs Institute (JBI) tools. Heterogeneity was assessed using the Galbraith plot, I² statistics, and Cochran’s Q test. Publication bias was examined with funnel plots and Egger’s test. A fixed-effects model was applied to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).
RESULTS: A total of 21 studies involving 32,709 women who underwent CS were included. Pooled analysis demonstrated that implementation of evidence-based intervention bundles significantly reduced the incidence of post-CS SSIs from 5% (95% CI: 1-8%) before intervention to nearly 0% (95% CI: 0-1%) after intervention (RR: 0.29, 95% CI: 0.27-0.31). This represents a 71% relative reduction in SSI risk. In absolute terms, bundle implementation translated into thousands of preventable infections and avoided complications across diverse settings.
CONCLUSION: Evidence-based bundles are a highly effective, practical, and adaptable strategy for reducing SSIs following caesarean delivery. Their integration into routine obstetric care can substantially improve maternal recovery, support early neonatal care including breastfeeding, and decrease healthcare costs associated with prolonged hospital stays. Adoption of such bundles should be prioritized globally, with particular urgency in LMICs where the burden of post-CS SSIs is highest.
PMID:41436971 | DOI:10.1186/s12884-025-08577-x
