Effects of placental delivery method and intraoperative glove changing on postcesarean febrile morbidity

Impact of changing gloves during cesarean section on postoperative infective complications: A systematic review and meta-analysis

INTRODUCTION

The cesarean section rate around the world, currently estimated at 21.1%, continues to increase. Women who undergo a cesarean section sustain a seven- to ten-fold greater risk of infective morbidity compared with those who deliver vaginally.

MATERIAL AND METHODS

We aimed to assess the impact of changing gloves intraoperatively on post-cesarean section infective morbidity (PROSPERO CRD42018110529). MEDLINE, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, and Cochrane Central were searched for randomized controlled trials until June 2020. Published randomized controlled trials that evaluated the effects of glove changing during cesarean section on infective complications were considered eligible for the review. Two reviewers independently selected studies, assessed the risk of bias, and extracted data about interventions and adverse maternal outcomes. Dichotomous variables were presented and included in the meta-analyses as risk ratios (RR) with 95% confidence intervals (CI). The quality of evidence was assessed using the GRADE approach in alignment with the recommendations from the Cochrane Review Group.

RESULTS

We identified seven randomized controlled trials reporting data over 1948 women. Changing gloves during a cesarean section was associated with a statistically significantly lower incidence of wound infective complications (RR 0.41, 95% CI 0.26-0.65, p < 0.0001; GRADE moderate quality evidence). This intervention seemed to be effective only if performed after delivery of the placenta. No significant difference was seen in the incidence of endometritis (RR 0.96, 95% CI 0.78-1.20, p = 0.74; GRADE moderate quality evidence) and/or febrile morbidity (RR 0.73, 95% CI 0.30-1.81, p = 0.50; GRADE moderate quality evidence), regardless of the timing of the intervention.

CONCLUSIONS

Changing gloves after delivery of the placenta during a cesarean section is associated with a significant reduction in the incidence of post-surgical wound complications compared with keeping the same gloves throughout the whole surgery. However, an adequately powered study to assess the limitations and cost-effectiveness of the intervention is needed before this recommendation can be translated into current clinical practice.

Changing gloves during cesarean section for prevention of postoperative infections: a systematic review and meta-analysis

This systematic review and meta-analysis was conducted to assess associations between changing gloves during cesarean section (CS) and postoperative infection. A literature search was conducted using the major electronic databases MEDLINE, Scopus, ISI Web of Science, PubMed, CINAHL, and CENTRAL from their inception to September 2020. Randomized controlled trials (RCTs) comparing glove change during CS to no glove change were included. Outcomes of interest were endometritis, febrile morbidity, and incisional surgical site infection (SSI). GRADE approach was applied to assess the quality of evidence. Ten reports of six studies involving 1707 participants were included in the analyses. Glove change was associated with a reduction in the risk of incisional SSI following CS (pooled RR 0.49, 95% CI 0.30, 0.78; moderate quality of evidence). Compared to no glove change, glove change during CS did not reduce the risks of endometritis (pooled RR 1.00, 95% CI 0.80, 1.24; low quality of evidence) or febrile morbidity (pooled RR 0.85, 95% CI 0.43, 1.71; very low quality of evidence). Changing gloves during CS was associated with a decreased risk of incisional SSI. The risks of postoperative endometritis and febrile morbidity were not altered by changing gloves.

The effect of peritoneal cavity saline irrigation at cesarean delivery on maternal morbidity and gastrointestinal system outcomes

OBJECTIVE

The objective of this study is to investigate the effect of peritoneal cavity saline irrigation during cesarean section (CS) on gastrointestinal disturbance and postoperative infectious morbidity (PIM).

METHODS

This prospective randomized clinic trial included 430 women who underwent elective or primary CS. The participants were randomized to either an irrigation of the abdominal cavity or the control group. The primary outcome measured was the rate of antiemetic drugs required in the postoperative period following CS. Secondary outcome measures included the rate of PIM.

RESULTS

Participants in both groups had similar demographic and clinical characteristics. The rate of antiemetic drugs required by patients was significantly higher in the irrigation group when compared with the control group (15.8% versus 8.4%, p = 0.018). The rate of intraoperative nausea and emesis (p ≤ 0.001) and the rate of postoperative nausea and emesis (p ≤ 0.001 and p = 0.018, respectively) were significantly higher in the irrigation group compared with the control group.

CONCLUSIONS

Irrigation with saline at the time of CS increases both intraoperative and postoperative nausea and emesis without any beneficial effects on PIM. Routine use of saline irrigation in the abdominal cavity does not seem to be reasonable.

Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial

OBJECTIVE

To compare blood loss with spontaneous delivery and manual removal of the placenta during caesarean section.

DESIGN

A randomised controlled trial.

SETTING

Four university hospitals between September 1999 and June 2002.

POPULATION

A total of 472 women delivering by caesarean section at term were randomised to spontaneous placental delivery (n= 235) or manual removal (n= 237).

METHODS

The allocation was made by opening the next available of a series of sealed opaque envelopes and derived from a computer-generated list of numbers.

MAIN OUTCOME MEASURES

Significant blood loss, defined as either a drop in haemoglobin of greater than 2.5 g/dL, or the need for blood transfusion.

RESULTS

The mean interval between delivery of the newborn and the placenta was longer in the spontaneous delivery group (3.4 vs 1.9 minutes), but the mean duration of the operation was similar. Significant blood loss occurred in 30 women (13%) in the spontaneous delivery group and 49 women (21%) in the manual removal one (RR 0.62; 95% CI 0.41-0.94). Post-operative fever affected 6 and 5 cases, respectively, and antibiotics were used in 14 and 12 cases, respectively.

CONCLUSIONS

Allowing spontaneous delivery of the placenta reduces significant blood loss without increasing operating time.