Necrotizing soft tissue infection of the abdominal wall following vaginal delivery in a ruptured uterus: a case series from Nigeria

Necrotizing soft tissue infections (NSTIs) in pregnancy and puerperium are rare but life-threatening, with high morbidity and mortality. Diagnosis is often delayed due to nonspecific symptoms. While commonly linked to cesarean delivery and pelvic surgeries, NSTIs can also arise in spontaneous vaginal deliveries. We report two postpartum NSTI cases in women following vaginal delivery in a silent uterine rupture that were managed in a low-resource setting in a rural part of Nigeria. Puerperal NSTIs require early recognition and aggressive management. Uterine rupture may be an unrecognized source of infection. Timely surgical debridement, broad-spectrum antibiotics, and supportive care are critical for survival. Diagnosis and management can be challenging in low-resource settings, and clinical suspicion with early surgical and medical intervention is essential for a positive outcome.