Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study

Leth, Rita Andersen; Uldbjerg, Niels; Nørgaard, Mette; Frimodt‐Møller, Niels; Thomsen, Reimar Wernich

doi:10.1111/j.1600-0412.2011.01090.x

Cited by 65 publications

(45 citation statements)

References 26 publications

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“…Most patients were primipara. Several risk factors may be involved including those predisposing to postpartum endomyometritis or postoperative hematoma formation [33][34][35][36][37][38][39]. In most cases, cesarean delivery was done in an emergency settings following the onset of labor and after the rupture of membranes (35% versus 22%), similar to the present case.…”

Section: Patients' Characteristics and Risk Factorssupporting

confidence: 66%

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Badr¹,

Hassan²,

Ramadan³

2017

J Clin Gynecol Obstet

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We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery, and report our brief review on risk factors, physiopathology and the management of this postpartum complication. We encountered a 25-year-old woman presenting to our emergency department (ED) with severe suprapubic pain and high grade fever. She had an urgent cesarean delivery performed 10 days prior to presentation due to fetal distress. At the ED, CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac and a passive drain inside the uterine cavity through the cervix and vagina. Postpartum uterine scar rupture secondary to infection and necrosis is a rare but serious complication of cesarean delivery. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients. A low threshold to diagnose this complication is warranted.

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Section: Patients' Characteristics and Risk Factorssupporting

confidence: 66%

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Badr¹,

Hassan²,

Ramadan³

2017

J Clin Gynecol Obstet

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“…The trend for increased prepregnancy BMI among type 1 diabetic patients might have partly encouraged the avoidance of elective CS, as obesity is a risk factor for surgical complications. Diabetes has been shown to further increase the already elevated risk of post-CS infections in obese pregnant women [38]. The concurrent increase in the emergency CS rate and the decreasing trend of mean UA pH in vaginal deliveries suggest failure to identify those high-risk type 1 diabetic patients for whom vaginal delivery might not have been the safest choice.…”

Section: Discussionmentioning

confidence: 99%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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“…Postoperative wound complications, such as infection, dehiscence, and formation of haematoma or seroma, are common complications of surgical procedures1, 2, particularly among patients with risk factors such as obesity and diabetes3, 4, 5. Postoperative wound complications may lead to increased healthcare costs due to prolonged inpatient stay, repeat surgery and the need for increased follow‐up6, 7.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

197

172

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study

Abstract: Obesity increases the risk of post-cesarean infections and diabetes further strengthens this association.

Cited by 65 publications

References 26 publications

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

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