Treatment of Cesarean Section Incision Seroma

Diagnosis and Assessment

The American College of Obstetricians and Gynecologists defines a seroma as a serous fluid collection under the skin flaps following surgery, which commonly occurs after procedures that create anatomical dead space, and seromas after cesarean section typically present as a fluctuant swelling at the incision site without significant erythema or systemic signs of infection 1
Seromas must be distinguished from surgical site infection (SSI), which would present with purulent drainage, pain, tenderness, redness, and induration 1

The primary treatment for a cesarean section incision seroma is prompt drainage of the fluid collection, followed by appropriate wound care to allow healing by secondary intention 1
For recurrent or large seromas, consider opening part of the incision to allow complete drainage, and continue dressing changes until the wound heals by secondary intention 1

Negative pressure wound therapy (NPWT) may be beneficial for chronic seromas by promoting granulation tissue formation and obliterating dead space, and has shown significant reduction in surgical site infections compared to standard dressings (pooled OR, 0.25; 95% CI, 0.12–0.52) 2

Antibiotics are NOT routinely indicated for uncomplicated seromas without signs of infection, according to the American College of Obstetricians and Gynecologists 1
Add antibiotics only if there are signs of infection with systemic involvement, such as temperature >38.5°C or heart rate >110 beats/minute, erythema extending >5 cm from the wound edge, or presence of purulent drainage or other signs of infection 1

The American College of Obstetricians and Gynecologists recommends using subcuticular suture for skin closure rather than staples to reduce wound complications 3
Consider negative pressure wound therapy for high-risk patients, as it has been shown to decrease postoperative seroma formation 2, 4

Monitor the wound until complete healing occurs, as recommended by the American College of Obstetricians and Gynecologists 1