Management of Wound Complications From Cesarean Delivery

Sarsam, Sue Ellen; Elliott, John P.; Lam, Garrett

doi:10.1097/01.ogx.0000166603.43959.aa

Cited by 102 publications

(27 citation statements)

References 41 publications

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“…Due to the nature of clinical practice in our facility, patients are followed up postoperatively in the community health clinics and not seen by the hospital physicians. To overcome this limitation, we obtained information about wound healing via standardized telephone interviews and found the rate of CD wound healing problems was in accordance with the current medical literature …”

Section: Discussionmentioning

confidence: 91%

“…Prevalence of cesarean delivery (CD) has been rising in the last decade and has reached 25%–50% of all deliveries . Although major wound complications after CD are relatively rare, affecting only 6%–13% of patients, minor complications, estimated to occur in about 25% of cases, constitute important factors impacting the puerperium, including length of admission, ability to care for the newborn, and scar appearance.…”

Section: Introductionmentioning

confidence: 99%

“…In general surgery, orthopedics, and plastic surgery, typical postoperative protocols include dressing removal on postoperative day 2–7 and staple removal on postoperative day 7–10 . In obstetrics, there is no uniform protocol and clinical practice is based on physician preference and experience rather than rigorous evidence . In our facility, the dressing is removed on postoperative day 1and staples are removed on postoperative day 3–4; however, there is no certainty that this is the ideal protocol for all.…”

Section: Introductionmentioning

confidence: 99%

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Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Heinemann

Solnica

Abdelkader

et al. 2019

Intl J Gynecology & Obste

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Objective To investigate optimal timing of dressing and staples removal after cesarean delivery (CD). Methods This prospective clustered clinical trial enrolled women undergoing CD between January 1, 2013, and October 31, 2014, at Hadassah–Hebrew University Hospital, Jerusalem. Women were assigned to one of five clusters differing in timing of dressing and staples removal. We assessed scar healing at 6 weeks. Results 920 women completed telephone questionnaires. Wound healing did not differ significantly among the clusters: the healing complication rate was 21% in the control group (n=46) and ranged from 18% to 26% (n=27–50) in clusters two to five (P=0.49). More healing complications were observed in women with a body mass index (BMI) of more than 35 kg/m2 versus 35 kg/m2 or less (P=0.016), urgent versus elective CD (P=0.013), preterm premature rupture of the membranes (PPROM) versus intact membranes (P=0.016), and chorioamnionitis at delivery versus no chorioamnionitis (P=0.001). 586 (64%) women underwent physician assessment at staples removal and at 6 weeks post CD. Conclusions Timing of dressing and staples removal has no effect on CD scar healing in low‐ and high‐risk parturients. A BMI of more than 35 kg/m2, urgent CD, PPROM, and chorioamnionitis were associated with mal‐healing, regardless of cluster. Clinicaltrials.gov: NCT01724255.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Heinemann

Solnica

Abdelkader

et al. 2019

Intl J Gynecology & Obste

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“…Aseptic fat liquefaction, as a main cause of prolonged healing of aseptic post‐surgical incision, is the necrosis of adipose tissue without infection and exhibits an incidence of 0·52–1·11% in all postoperative wounds (1–3). It is more common in older or overweight patients complicated with diabetes or malnutrition (4–6), which, besides the disease and operation, increases stress and economic burdens on patients and their families. Many preclinical and clinical interventions have shown their efficacy in promoting wound healing, including topical application of honey, hormones, insulin‐zinc, negative pressure therapy, low‐level laser energy, antibiofilm, microRNA and statins (7–14).…”

Section: Introductionmentioning

confidence: 99%

Insulin and hypertonic glucose in the management of aseptic fat liquefaction of post‐surgical incision: a meta‐analysis and systematic review

Shi

Wang

et al. 2012

International Wound Journal

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A meta-analysis and systematic review assessing randomised controlled trials (RCTs) was sought to determine whether subcutaneous injection of insulin with hypertonic glucose promotes healing in postoperative incisions with aseptic fat liquefaction. We searched the Cochrane library, Pubmed, EMBASE, National Science Digital Library (NSDL) and China Biological Medicine Database (CBMdisc) for literature published from 1 January 1990 to 30 September 2011. RCTs that evaluated subcutaneous injection of insulin with hypertonic glucose as a treatment for postoperative wound with fat liquefaction were sought. Wound healing was the primary endpoint. Jadad score and Cochrane Collaboration's tool were used for assessing quality of studies and risk of bias. We abstracted data regarding time to wound healing, cost and adverse effects. The random-effects inverse variance model was used for all analyses using weighted mean difference and 95% confidence interval. Eight trials (414 participants) were identified that met the inclusion criteria. Subcutaneous injection of insulin with hypertonic glucose significantly reduces time to healing by 6·33 days compared with conventional drainage, with less cost. There was no report concerning adverse effects. Subcutaneous injection of insulin with hypertonic glucose may improve the healing process in postoperative wounds with aseptic fat liquefaction.

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“…Albania in the last decade, saw an increase rate of cesarean births which was approximately 31 to 33% (Glozheni 2008), somewhat unjustified (because it has not improved perinatal mortality, reason that can justify this increase in the number of cesarean births) but, even more increases the chances of complications (Althabe and Sosa, 2006;Belizan et al, 2006). Among these complications we can mention: infections (where women who perform the cesarean birth are 20 times more at risk of infections and infective disease than a woman who gave birth through the vaginal) (Conroy et al, 2012;Jido and Grarba, 2012;Sarsam et al, 2005;Smaill and Gyte, 2010), negative impact on breastfeeding (Kuguoglu et al, 2012;Parthasarathy and Rajah, 2011), hemorrhage, pulmonary embolism, urinary tract trauma, risk of uterine rupture in future pregnancies, etc. (Dumont et al, 2001, Grella PV et al, 2006.…”

Section: Introductionmentioning

confidence: 99%

The reasons of rising trend of cesarean section rate year after year. A retrospective study

Gjonej¹,

Poloska²,

Keta³

et al. 2015

Int. J. Nurs. Midwifery

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Cesarean section is a surgical procedure which allows the child to birth through uterus incision. Cesarean birth is a procedure that gives resolve problems such as maternal and fetal complications. Indications that are most important in this study that have contributed to an increase in the number of cesarean births are preeclampsia (9.2%), fetal suffering (13.9%), premature rupture of membranes (9.8%) and the indication which has greater influence in the rising rate of cesarean delivery is previous cesarean births (36.5%). The most frequent reasons for cesarean births in the center where the study was conducted for years January, 2011 till December, 2013 are: previous cesarean section, preeclampsia, fetal suffering. So, previous cesarean births are the most important factor in making decisions about the way of delivery, while in 1982 to 1984 the important factor was fetal suffering. Previous cesarean birth and multiple pregnancies (due to the increased number of in vitro fertilization) represent a growing trend. However, this high percentage of cesarean births in our center is unwarranted, so physicians should be very careful when they select patients for cesarean section. Careful monitoring of the fetus will help in reducing cesarean birth rate in our hospital.

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Management of Wound Complications From Cesarean Delivery

Abstract: After completion of this article, the reader should be able to describe the effects of obesity on cesarean delivery wound healing, to improve methods of wound healing in the obese patient, and to explain why wet to dry dressing changes are not effective wound management.

Cited by 102 publications

References 41 publications

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Insulin and hypertonic glucose in the management of aseptic fat liquefaction of post‐surgical incision: a meta‐analysis and systematic review

The reasons of rising trend of cesarean section rate year after year. A retrospective study

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