Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Wound Infection | Research article

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

Authors: Amanda J. Poprzeczny, Rosalie M. Grivell, Jennie Louise, Andrea R. Deussen, Jodie M. Dodd

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

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 ACTRN12608000143​325, on the 20th March, 2008.
Literature
1.
Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201–209f.PubMedPubMedCentralCrossRef
2.
Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tuncalp O, Mori R, Morisaki N, Ortiz-Panozo E, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260–70.PubMedCrossRef
3.
World Health Organisation. WHO statement on caesarean section rates. Reprod Health Matters. 2015;23(45):149–50.CrossRef
4.
Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM. WHO statement on caesarean section rates. BJOG. 2016;123(5):667–70.PubMedCrossRef
5.
Betrán AP, Zhang J, Torloni MR, Gülmezoglu AM. Determination of a single, universal threshold for caesarean section rate is not the way forward. Evid Based Med. 2016;21(6):237.PubMedPubMedCentralCrossRef
6.
Australian Institute of Health and Welfare. In: AIoHa W, editor. Australia’s mothers and babies 2015 - in brief. Edited by. Canberra: AIHW; 2017.
7.
Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.PubMedPubMedCentralCrossRef
8.
MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293–307 v.PubMedCrossRef
9.
Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, van der Meulen JH. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010;341:c5065.PubMedPubMedCentralCrossRef
10.
Johnson A, Young D, Reilly J. Caesarean section surgical site infection surveillance. J Hosp Infect. 2006;64(1):30–5.PubMedCrossRef
11.
Leth RA, Møller JK, Thomsen RW, Uldbjerg N, Nørgaard M. Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women. Acta Obstet Gynecol Scand. 2009;88(9):976–83.PubMedCrossRef
12.
Hung HW, Yang PY, Yan YH, Jou HJ, Lu MC, Wu SC. Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women. J Matern Fetal Neonatal Med. 2016;29(10):1665–72.PubMedCrossRef
13.
Tran TS, Jamulitrat S, Chongsuvivatwong V, Geater A. Risk factors for postcesarean surgical site infection. Obstet Gynecol. 2000;95(3):367–71.PubMed
14.
Shea SK, Soper DE. Prevention of cesarean delivery surgical site infections. Obstet Gynecol Surv. 2019;74(2):99–110.PubMedCrossRef
15.
Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv. 2005;60(7):462–73.PubMedCrossRef
16.
Tully L, Gates S, Brocklehurst P, McKenzie-McHarg K, Ayers S. Surgical techniques used during caesarean section operations: results of a national survey of practice in the UK. Eur J Obstet Gynecol Reprod Biol. 2002;102(2):120–6.PubMedCrossRef
17.
Demers S, Roberge S, Afiuni YA, Chaillet N, Girard I, Bujold E. Survey on uterine closure and other techniques for caesarean section among Quebec’s obstetrician-gynaecologists. J Obstetr Gynaecol Canada. 2013;35(4):329–33.CrossRef
18.
Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(3):682–90.PubMedCrossRef
19.
Mackeen AD, Berghella V, Larsen ML. Techniques and materials for skin closure in caesarean section. Cochrane Database syst Rev. 2012;11:Cd003577.PubMed
20.
Vats U, Pandit Suchitra N. Comparison of efficacy of three suture materials, i.e., poliglecaprone 25, polyglactin 910, polyamide, as subcuticular skin stitches in post-cesarean women: a randomized clinical trial. J Obstetr Gynecol India. 2014;64(1):14–8.CrossRef
21.
Pergialiotis V, Prodromidou A, Perrea DN, Doumouchtsis SK. The impact of subcutaneous tissue suturing at caesarean section on wound complications: a meta-analysis. BJOG. 2017;124(7):1018–25.PubMedCrossRef
22.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.PubMedCrossRef
23.
Gates S, Anderson ER. Wound drainage for caesarean section. Cochrane Database Syst Rev. 2013;12:CD004549.
24.
Reilly J, Allardice G, Bruce J, Hill R, McCoubrey J. Procedure-specific surgical site infection rates and postdischarge surveillance in Scotland. Infect Control Hosp Epidemiol. 2006;27(12):1318–23.PubMedCrossRef
25.
26.
Chunder A, Devjee J, Khedun SM, Moodley J, Esterhuizen T. A randomised controlled trial on suture materials for skin closure at caesarean section: Do wound infection rates differ? South Afr Med J. 2012;102(6 Pt 2):374–6.CrossRef
27.
Cromi A, Ghezzi F, Gottardi A, Cherubino M, Uccella S, Valdatta L. Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. Am J Obstetr Gynecol. 2010;203(1):36.e31–8.CrossRef
28.
Rezaie Kahkhaie K, Rezaie Keikhaie K, Shahreki Vahed A, Shirazi M, Amjadi N. Randomized comparison of nylon versus absorbing polyglactin 910 for fascial closure in caesarean section. Iran Red Crescent Med J. 2014;16(4):e12580.PubMedPubMedCentralCrossRef
29.
Ethicon Johnson & Johnson: Coated Vycril Suture Product Information. 4 edn; 2015.
30.
31.
32.
Bezwada RS, Jamiolkowski DD, Lee IY, Agarwal V, Persivale J, Trenka-Benthin S, Erneta M, Suryadevara J, Yang A, Liu S. Monocryl suture, a new ultra-pliable absorbable monofilament suture. Biomaterials. 1995;16(15):1141–8.PubMedCrossRef
33.
Conn J Jr, Oyasu R, Welsh M, Beal JM. Vicryl (polyglactin 910) synthetic absorbable sutures. Am J Surg. 1974;128(1):19–23.PubMedCrossRef
34.
35.
Chelmow D, Huang E, Strohbehn K. Closure of the subcutaneous dead space and wound disruption after cesarean delivery. J Matern Fetal Neonatal Med. 2002;11(6):403–8.PubMedCrossRef
36.
Allaire AD, Fisch J, McMahon MJ. Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. J Reprod Med. 2000;45(4):327–31.PubMed
37.
Cetin A, Cetin M. Superficial wound disruption after cesarean delivery: effect of the depth and closure of subcutaneous tissue. Int J Gynaecol Obstetr. 1997;57(1):17–21.CrossRef
38.
Scheil WJK, Scott J, Catcheside B, Sage L, Kennare R. Pregnancy Outcome in South Australia 2014. In: Edited by Pregnancy Outcome (Statistics) Unit SH, Government of South Australia. Adelaide: SA Health; 2016.
39.
Dalenius K, Brindley PL, Smith BL, Reinold CM, Grummer-Strawn L. Pregnancy nutrition surveillance 2010 report. Atlanta: Edited by U.S. Department of Health and Human Services CfDCaP; 2012.
40.
Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG. 2007;114(2):187–94.PubMedCrossRef
41.
Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynecol Obstet. 2005;90(1):10–5.CrossRef
42.
Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002;100(5 Pt 1):959–64.PubMed
Metadata
Title
Skin and subcutaneous fascia closure at caesarean section to reduce wound complications: the closure randomised trial
Authors
Amanda J. Poprzeczny
Rosalie M. Grivell
Jennie Louise
Andrea R. Deussen
Jodie M. Dodd
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03305-z

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

Psychometric properties of the Malay version of the Women’s Views of Birth Labour Satisfaction Questionnaire using the Rasch measurement model: a cross sectional study

Research article

Is perinatal asphyxia predictable?

Research article

Maternal near miss and mortality attributable to hypertensive disorders in a tertiary hospital, Tanzania; a cross-sectional study

Research article

Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort

Research article

Interventions for women who report domestic violence during and after pregnancy in low- and middle-income countries: a systematic literature review

Research article

Iron stores in pregnant women with sickle cell disease: a systematic review