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Fakhr MS, Mozafari M, Rezvanfar K, Amini Z, Amiri K, Hosseini RS, Sarnaz H, Gholami P, Lavasani Z. Investigating the risk factors for isthmocele development after cesarean delivery. AJOG GLOBAL REPORTS 2024; 4:100299. [PMID: 38725541 PMCID: PMC11078695 DOI: 10.1016/j.xagr.2023.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar. OBJECTIVE This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery. STUDY DESIGN This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele. RESULTS Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m2), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele. CONCLUSION Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.
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Affiliation(s)
- Masoud Saadat Fakhr
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Mahya Mozafari
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Kiana Rezvanfar
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Zahra Amini
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Koosha Amiri
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Reza Shah Hosseini
- Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey (Mr Hosseini)
| | - Hengame Sarnaz
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Poorya Gholami
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami)
| | - Zohreh Lavasani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran (Dr Lavasani)
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Sibomana O, Bugenimana A, Oke GI, Egide N. Prevalence of post-caesarean section surgical site infections in Rwanda: A systematic review and meta-analysis. Int Wound J 2024; 21:e14929. [PMID: 38772859 PMCID: PMC11108763 DOI: 10.1111/iwj.14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
Caesarean section (C-section) is the most performed major surgery worldwide. About 15% of births are delivered through C-section in Rwanda. The post-caesarean surgical section is one of the most frequent complications that follow a C-section. The purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of surgical site infections following caesarean section deliveries in Rwanda. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, DOAJ, AJOL and the Cochrane Library to identify primary studies on post-caesarean surgical site infections in Rwanda. Studies meeting predetermined criteria were included, and their quality was assessed using the JBI Critical Appraisal Tools. Heterogeneity was evaluated using I2 statistics, while publication bias was examined via funnel plots and statistical tests. Pooled prevalence was calculated using Jamovi 2.3.28 software, with subgroup analysis conducted to identify sources of heterogeneity. Statistical significance was set at p < 0.05. From 139 articles initially searched from the databases, only 17 studies with 8, 082 individuals were finally included in the systematic review and meta-analysis. Using the random-effects model, the pooled estimate of post C-section SSIs prevalence in Rwanda was 6.85% (95% CI 5.2, 8.5). Subgroup analysis based on publication year, sample size, hospital and study design showed no much difference in SSI prevalence. The current systematic review and meta-analysis indicates that post-caesarean surgical site infections are significant in Rwanda. A collaborative effort is required to lower post-C-section SSIs and provide the best surgical care in the country.
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Affiliation(s)
- Olivier Sibomana
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Athanasie Bugenimana
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Ndayambaje Egide
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Wondmeneh TG, Mohammed JA. The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1395158. [PMID: 38725468 PMCID: PMC11079214 DOI: 10.3389/fmed.2024.1395158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Background Although surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia. Methods We searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out. Results Twenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96-16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15-3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24-2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45-6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22-2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54-4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93-5.92) were independent risk factors for surgical site infections. Conclusion More than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.
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Prabha Shankar A, Br KK, Shankar B, Babu RH, Dholariya R, Priya, Muralidhar S, Subramanya GM. Oncological Surgical Wound Care: A Comparison of Theruptor NXT Non-adherent Dressing and the Current Standard of Care. Cureus 2024; 16:e56593. [PMID: 38650774 PMCID: PMC11034897 DOI: 10.7759/cureus.56593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background Oncological surgeries pose an elevated risk of surgical site infections (SSIs) due to their complexity and various associated treatments, impacting patient outcomes and healthcare costs. This has prompted a focus on advanced wound dressings that provide microbial protection, exudate absorption, and improved product performance, enhancing patient satisfaction. Our study aimed to compare the efficacy and safety of Theruptor NXT with the current standard of care (SOC) practice involving cotton/povidone/micropore dressings in the postoperative wound management of oncological surgeries. Methodology A total of 102 patients who underwent oncological surgeries in the Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India between May and September 2023 were randomized to Theruptor NXT and SOC dressing groups (51 patients each). The incidence of SSIs, wound pain score, cosmetic appearance of the wound, and adverse events were assessed in the two groups at various intervals, i.e., post-surgery day 2 ± 1, day of discharge, and post-surgery day 30 ± 7. Further, the subject satisfaction and product usage were evaluated on post-surgery day 2 ± 1. Results The baseline characteristics were found to be comparable in both groups, i.e., Theruptor NXT and SOC groups. Further, the SSI rates, scar outcomes, and physiological parameters were also similar between the Theruptor NXT and SOC groups, indicating a similar safety profile of both dressings (p > 0.05). However, the product usage assessment revealed statistically significant differences, favoring Theruptor NXT in terms of superior ease of application, stretchability, exudate management, breathability, and non-adherence properties (p < 0.05). Conclusions Our findings suggest that Theruptor NXT wound dressing is a promising, effective, and user-friendly alternative to SOC wound dressing in diverse clinical settings.
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Affiliation(s)
- Amritha Prabha Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Kiran Kumar Br
- Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Bharat Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ravoori H Babu
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Rahul Dholariya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Priya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Shubhashree Muralidhar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ganesh M Subramanya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
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Dong H, Song J, Jia Y, Cui H, Chen X. A comprehensive study on the risk factors and pathogen analysis of postoperative wound infections following caesarean section procedures. Int Wound J 2024; 21:e14609. [PMID: 38272798 PMCID: PMC10801270 DOI: 10.1111/iwj.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Postoperative wound infections (PWIs), a subtype of surgical site infections, are a significant concern for patients undergoing caesarean sections (C-sections). Understanding risk factors and pathogen profiles can greatly assist in early diagnosis and effective treatment. This study aimed to identify risk factors and analyse the pathogenic landscape contributing to PWIs in C-sections. A nested case-control study was carried out, utilising stringent criteria for case selection and control matching. Diagnostic criteria for surgical site infections included both clinical and microbiological parameters. Risk variables examined included patient age, Body Mass Index, duration of surgery and several other clinical indicators. Microbiological analysis was performed using the BD Phoenix-100 Automated Bacterial Identification System. Statistical analyses were conducted using SPSS version 26.0, and risk factors were evaluated through both univariate and multivariate analyses. A total of 50 patients, aged between 20 and 45 years (mean age 26.3 ± 5.6), developed PWIs following C-sections. The study revealed a temporal distribution and various clinical indicators of PWIs, including elevated white blood cell count and C-reactive protein levels. Gram-negative bacteria were found to be more prevalent at 57.4%. Notable pathogens included Pseudomonas aeruginosa and Acinetobacter baumannii. Antimicrobial resistance patterns were also identified, highlighting the need for a targeted antibiotic approach. Increased infection risks were linked to lack of prophylactic antibiotics, absence of preoperative povidone-iodine antisepsis, operations over an hour, anaemia, amniotic fluid contamination, diabetes, GTI, premature rupture of membranes and white blood cells counts above 10 × 109 /L. The study provides critical insights into the risk factors and microbial agents contributing to PWIs following C-sections. Our findings emphasise the importance of early diagnosis through clinical and laboratory parameters, as well as the need for constant surveillance and reassessment of antibiotic stewardship programs.
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Affiliation(s)
- Hui Dong
- School of Medicine, Nankai UniversityTianjinChina
- Tianjin Key Laboratory of Human Development and Reproductive RegulationTianjinChina
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Jie Song
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
- Tianjin Medical UniversityTianjinChina
| | - Yanju Jia
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Hongyan Cui
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Xu Chen
- School of Medicine, Nankai UniversityTianjinChina
- Tianjin Key Laboratory of Human Development and Reproductive RegulationTianjinChina
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
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Birgand G, Dhar P, Holmes A. The threat of antimicrobial resistance in surgical care: the surgeon's role and ownership of antimicrobial stewardship. Br J Surg 2023; 110:1567-1569. [PMID: 37758500 PMCID: PMC10638523 DOI: 10.1093/bjs/znad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Gabriel Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Regional Center for Infection Prevention and Control, Region of Pays de la Loire, Nantes University Hospital, Nantes, France
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes, France
| | - Puneet Dhar
- Surgical Gastroenterology, Amrita Hospital, Faridabad, India
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Faculty of Health Sciences, University of Liverpool, Liverpool, UK
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