Skin and subcutaneous fascia closure at caesarean section to reduce wound complications: the closure randomised trial.

Published on Oct 8, 2020in BMC Pregnancy and Childbirth2.239
· DOI :10.1186/S12884-020-03305-Z
Amanda Poprzeczny3
Estimated H-index: 3
(University of Adelaide),
Rosalie M Grivell24
Estimated H-index: 24
(Flinders University)
+ 2 AuthorsJodie M Dodd50
Estimated H-index: 50
(University of Adelaide)
Sources
Abstract
BACKGROUND Wound infection is a common complication following caesarean section. Factors influencing the risk of infection may include the suture material for skin closure, and closure of the subcutaneous fascia. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section. METHODS Women undergoing caesarean birth at an Adelaide maternity hospital were eligible for recruitment to a randomised trial using a 2 × 2 factorial design. Women were randomised to either closure or non-closure of the subcutaneous fascia and to subcuticular skin closure with an absorbable or non-absorbable suture. Participants were randomised to each of the two interventions into one of 4 possible groups: Group 1 - non-absorbable skin suture and non-closure of the subcutaneous fascia; Group 2 - absorbable skin suture and non-closure of the subcutaneous fascia; Group 3 - non-absorbable skin suture and closure of the subcutaneous fascia; and Group 4 - absorbable skin suture and closure of the subcutaneous fascia. The primary outcomes were reported wound infection and wound haematoma or seroma within the first 30 days after birth. RESULTS A total of 851 women were recruited and randomised, with 849 women included in the analyses (Group 1: 216 women; Group 2: 212 women; Group 3: 212 women; Group 4: 211 women). In women who underwent fascia closure, there was a statistically significant increase in risk of wound infection within 30 days post-operatively for those who had skin closure with an absorbable suture (Group 4), compared with women who had skin closure with a non-absorbable suture (Group 3) (adjusted RR 2.17; 95% CI 1.05, 4.45; p = 0.035). There was no significant difference in risk of wound infection for absorbable vs non-absorbable sutures in women who did not undergo fascia closure. CONCLUSION The combination of subcutaneous fascia closure and skin closure with an absorbable suture may be associated with an increased risk of reported wound infection after caesarean section. TRIAL REGISTRATION Prospectively registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12608000143325 , on the 20th March, 2008.
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ImportanceSurgical site infection (SSI) is a common complication of cesarean delivery. Seen in up to 12% of cesarean deliveries, it is a major cause of prolonged hospital stay and a burden to the healthcare system. Interventions and techniques must be identified to decrease the risk of cesarean deli
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#1Vasilios Pergialiotis (Athens State University)H-Index: 22
#2Anastasia Prodromidou (Athens State University)H-Index: 16
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Background Caesarean wound complications are frequently observed in everyday practice. Objectives To study whether subcutaneous tissue closure following caesarean section results in decreased wound complications. Search strategy We systematically searched Medline (1966–2016), Scopus (2004–2016), ClinicalTrials.gov (2008–2016) and Cochrane Central Register of Controlled Trials CENTRAL (1999–2016) databases together with reference lists from included studies. Selection criteria Randomised and quas...
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Commentary on: Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA 2015;314:2263–70.[OpenUrl][1][CrossRef][2][PubMed][3] Over the past decades, the steady rise in caesarean section rates worldwide has led to increased research, debate and concern among clinicians, scientists, policymakers and governments, with sustained questions: What is the appropriate caesarean section rate? What is the rate or range that achieves best ...
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AbstractObjective: To compare the short-term maternal postpartum complications associated with cesarean section (CS), vaginal delivery (VD), repeated CS and vaginal birth after cesarean section (VBAC) in a large national sample.Methods: This was a population-based study of the Taiwan National Health Insurance Research Database (NHIRD). Outcomes include post-discharge (2 weeks) urinary tract infection (p-UTI), complications of obstetrical surgical wounds (p-wound) and postpartum hemorrhage (p-hem...
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Summary Background Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis...
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