Background
Postcesarean wound morbidity is a costly complication of cesarean delivery for which preventative strategies remain understudied.
Objective
We compared surgical site occurrences (SSOs) in cesarean patients receiving closed-incision negative-pressure therapy (ciNPT) or standard-of-care (SOC) dressing.
Study Design
A single-center randomized controlled trial compared ciNPT (5–7 days) to SOC dressing (1–2 days) in obese women (body mass index [BMI] ≥ 35), undergoing cesarean delivery between 2012 and 2014. Participants were randomized 1:1 and monitored 42 ± 10 days postoperatively. The primary outcome SSOs included unanticipated local inflammation, wound infection, seroma, hematoma, dehiscence, and need for surgical or antibiotic intervention.
Results
Of the 92 randomized patients, 82 completed the study. ciNPT and SOC groups had similar baseline characteristics. Mean BMI was 46.5 ± 6.5 and no treatment-related serious adverse events. Compared with SOC, the ciNPT group had fewer SSOs (7/43 [16.3%] vs. 2/39 [5.1%], respectively;
p
= 0.16); significantly fewer participants with less incisional pain both at rest (39/46 [84.8%] vs. 20/46 [43.5%];
p
< 0.001) and with incisional pressure (42/46 [91.3%] vs. 25/46 [54.3%];
p
< 0.001); and a 30% decrease in total opioid use (79.1 vs. 55.9 mg morphine equivalents,
p
= 0.036).
Conclusion
A trend in SSO reduction and a statistically significant reduction in postoperative pain and narcotic use was observed in women using ciNPT.
The transgender community has faced a long-standing history of prejudice and discrimination that has negatively affected their health. A lack of health care provider education and comfort with transgender medicine further challenges the ability of this population to obtain competent, gender-affirming medical care. As with all patients, a thorough patient history with avoidance of assumptions of sexual orientation based on gender identity is integral to providing appropriate care for transgender individuals. Vaginal bleeding in transgender men should be evaluated in a similar manner to natal women, and with knowledge of the individual's present reproductive organs. The majority of transgender men receiving gender-affirming hormone therapy will have cessation of menses by 6 months of continuous use; thus, bleeding beyond this interval warrants measurement of hormone levels and further evaluation. Progesterone-only contraceptive methods including progesterone-only pills, medroxyprogesterone acetate, or a levonorgestrel intrauterine device can be used in transgender men and nonbinary patients with continued menses despite physiologic testosterone levels, or to act as a bridge method for menstrual cessation at the time of testosterone initiation. For bleeding refractory to progesterone methods, health care providers should discuss surgical options or the use of aromatase inhibitors with their patients. Counseling on fertility desires and family planning is integral to improving the reproductive care of transgender patients. Contraceptive counseling for transgender patients should include not only the efficacy and ease of use of available methods, but also discussion of advantages and disadvantages of contraceptive options with regard to the patient's gender identity.
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