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Andzane D, Miskova A, Krone A, Rezeberga D. Impact of Intraoperative Factors on the Development of Postpartum Septic Complications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1637. [PMID: 37763756 PMCID: PMC10536124 DOI: 10.3390/medicina59091637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Triclosan-coated sutures (antibacterial sutures) can reduce the risk of postoperative surgical site infection. This study aimed to investigate the effect of intraoperative factors, including antibacterial sutures, on the risk of postpartum septic complications. Materials and Methods: The prospective study included patients who underwent caesarean section. The exclusion criterion was chorioamnionitis. The investigation group patient's (n = 67) uterus and fascial sheath of the abdominal wall were sutured with triclosan-coated polyglactin 910 sutures during surgery. The control group consisted of 98 patients using uncoated polyglactin 910 sutures only. The patients were contacted by phone after the 30th postoperative day. Results: No significant difference was found between the investigation group and the control group in the development of postpartum endometritis (11.7% in the investigation group vs. 8.4% in the control group, p = 0.401), wound infection (6.3% vs. 3.6%, p = 0.444) or patients experienced any septic complication (15.9% vs. 12%, p = 0.506). Postpartum endometritis was more common in patients who underwent instrumental uterine examination during the surgery (23.8% vs. 18%, p = 0.043). A moderately strong correlation was found for haemoglobin level on the third-fourth postoperative day with the development of postpartum septic complications, p < 0.001, Pearson coefficient -0.319. Post-caesarean delivery septic complications were not statistically more common in patients with blood loss greater than 1 L. The incidence of post-caesarean endometritis was 13.4%, and wound infection was 4.8% in this study's hospital, having five to six thousand deliveries per year. Conclusions: Using antibacterial sutures during caesarean section does not affect the incidence of postpartum septic complications. Instrumental uterine examination during caesarean section increases the risk of post-caesarean endometritis and is, therefore, not recommended. Haemoglobin level on the 3rd-4th postoperative day, rather than the estimated blood loss during surgery, affects the development of postpartum septic complications.
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Affiliation(s)
- Diana Andzane
- Riga Maternity Hospital, Miera Street 45, LV-1013 Riga, Latvia; (A.M.); (A.K.); (D.R.)
- Gynaecology Clinic, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, Miera Street 45, LV-1013 Riga, Latvia
- Department of Clinical Skills and Medical Technologies, Rīga Stradiņš University, Anninmuizas Bulvaris 26a, LV-1067 Riga, Latvia
| | - Anna Miskova
- Riga Maternity Hospital, Miera Street 45, LV-1013 Riga, Latvia; (A.M.); (A.K.); (D.R.)
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, Miera Street 45, LV-1013 Riga, Latvia
- Department of Clinical Skills and Medical Technologies, Rīga Stradiņš University, Anninmuizas Bulvaris 26a, LV-1067 Riga, Latvia
| | - Antra Krone
- Riga Maternity Hospital, Miera Street 45, LV-1013 Riga, Latvia; (A.M.); (A.K.); (D.R.)
| | - Dace Rezeberga
- Riga Maternity Hospital, Miera Street 45, LV-1013 Riga, Latvia; (A.M.); (A.K.); (D.R.)
- Gynaecology Clinic, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, Miera Street 45, LV-1013 Riga, Latvia
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INFEXIT: implementing vaginal disinfection prior to cesarean section. Eur J Obstet Gynecol Reprod Biol 2022; 279:55-59. [DOI: 10.1016/j.ejogrb.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
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Fadlalmola HA, Al-Sayaghi KM, Al-Hebshi AA, Alshengeti AM, Almohammadi NH, Alawfi AD, Aljohani MM, Elhaddad NF. Vaginal preparation with different antiseptic solutions before cesarean section for preventing postoperative infections: A systematic review and network meta-analysis. J Obstet Gynaecol Res 2022; 48:2659-2676. [PMID: 35904080 DOI: 10.1111/jog.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/20/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
AIMS We aimed to investigate the effect of various vaginal wash solutions on reducing risks of post-cesarean endometritis, wound infections, fever, and hospital stay duration. METHODS Scopus, Web of Science, PubMed, and Cochrane Library were searched for randomized clinical trials that compared different vaginal wash solutions to each other or to "no vaginal cleaning"; without restriction on the age of parturients or site where trials were conducted. We analyzed this frequentist network meta-analysis using the netmeta package in R software version 4.1.2; synthesized data as mean difference or risk ratio with their 95% confidence intervals. RESULTS Our network meta-analysis included 29 RCTs with a total sample size of 9311 women undergoing CS. Regarding post-cesarean endometritis, we found that povidone-iodine had the highest significant risk reduction compared to "no vaginal cleaning" (RR = 0.08, 95% CI [0.01, 0.69]). While regarding post-cesarean reduction of wound infection, fever, and hospital stay duration, we found that chlorhexidine 4% (RR = 0.17, 95% CI [0.05, 0.65]), saline 0.9% (RR = 0.12, 95% CI [0.03; 0.48]), and saline 0.9% (MD = -1.29, 95% CI [-2.18; -0.39]), respectively, had the highest significant risk reduction compared to "no vaginal cleaning." CONCLUSION Vaginal wash solutions were associated with a significant reduction of post-cesarean endometritis, wound infection, fever, and hospital stay duration. Since povidone-iodine had the highest significant reduction of post-cesarean endometritis, we recommend setting povidone-iodine as the standard practice as pre cesarean vaginal wash solution; consistent practice guidelines of Enhanced Recovery After Surgery (ERAS).
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Affiliation(s)
- Hammad Ali Fadlalmola
- Nursing College, Department of Community Health Nursing, Taibah University, Medina, Saudi Arabia
| | - Khaled Mohammed Al-Sayaghi
- Nursing College, Department of Medical Surgical Nursing, Taibah University, Medina, Saudi Arabia.,Nursing Division, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulqader Abdlah Al-Hebshi
- Department of Pediatrics, Prince Mohammed Bin AbdulAziz Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amer Mohammad Alshengeti
- Department of Pediatrics, College of Medicine, Taibah University, Almadinah, Saudi Arabia.,Infection Prevention and Control Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Almadinah, Saudi Arabia
| | - Nawal H Almohammadi
- Faculty of Medicine, Department of Pathology, Taibah University, Medina, Saudi Arabia
| | | | - Maher M Aljohani
- Department of Pathology, College of Medicine, Taibah University, Medina, Saudi Arabia.,Department of Pathology and Laboratory Medicine, Prince Mohammed Bin Abdulaziz Hospital, Medina, Saudi Arabia
| | - Nourhan F Elhaddad
- Obstetrics and Gynecology Department, Prince Mohammed Bin Abdul Aziz Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Wade-Vuturo A, Heaps S, Howard M, Goetzinger KR, Crimmins SD. Real-world implementation of a vaginal preparation policy prior to cesarean delivery. J Matern Fetal Neonatal Med 2022; 35:9430-9434. [PMID: 35168446 DOI: 10.1080/14767058.2022.2040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are a major source of morbidity and mortality for women who undergo cesarean section (c-section). SSIs following c-section include wound infection, infection of the endometrium (endometritis) and intra-abdominal infections. Perioperative interventions to prevent these infections continue to be studied, including the use of vaginal preparation prior to c-section. Although literature has shown that the use of vaginal preparation prior to c-section decreases the rate of SSI, real-world clinical data regarding effective implementation of these policies are lacking. The objectives of this study were to determine (1) if a vaginal preparation policy could be implemented in a real-world setting with a high compliance rate and (2) to identify factors led to differences in compliance with policy. STUDY DESIGN This was a secondary analysis of a retrospective cohort study designed to examine the incidence of SSI after c-section before and after the implementation of vaginal preparation policy. The primary outcomes included implementation rates of the vaginal preparation for the post policy cohort. Secondary outcomes included subgroup analysis of policy adherence based on time of day, urgency of delivery, membrane status, labor status, and maternal factors. RESULTS Overall adherence to the vaginal preparation policy was 87.2% of patients. Maternal factors did not impact the rate of policy adherence. 81.4% of patients undergoing c-section at night had vaginal prep completed compared to 89.9% of patients undergoing c-section during the day (p = .016). 63.8% of patients undergoing emergent c-section had vaginal prep completed, compared to 90.1% of patients undergoing non-emergent c-section (p < .001). Laboring patients were more likely to have vaginal preparation completed (143 (95.3%) vs. 225 (82.7%), p = .009). CONCLUSIONS Compliance with vaginal preparation policy was high. Patients who are undergoing evening deliveries and emergent deliveries are less likely to have vaginal preparation completed. Some of these differences are likely attributable to perceived urgency of the c-section. It is important that interventions are identified such as staff education and standardization of documentation to improve rates of policy adherence.
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Affiliation(s)
- Ashley Wade-Vuturo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Heaps
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Malina Howard
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine R Goetzinger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
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Bağlı İ, Ege S, Bademkıran H, Obut M, Kahveci B, Turan G, Kahramanoğlu Ö. The effect of vaginal disinfection on reducing post-caesarean endometritis: A prospective, randomised controlled trial. J Gynecol Obstet Hum Reprod 2020; 50:101981. [PMID: 33186774 DOI: 10.1016/j.jogoh.2020.101981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE We aimed to evaluate the efficacy of vaginal disinfection using 10 % povidone-iodine on rates of endometritis from post-caesarean infectious diseases before elective caesarean section (CS). METHODS A total of 270 pregnant women who chose to undergo elective CS were recruited for this prospective randomised controlled study. The experimental group comprised 130 patients who had preoperatively undergone vaginal disinfection with 10 % povidone-iodine for 30 s. The control group consisted of 140 patients who had not undergone any vaginal implication before CS. The primary outcome measure was the rate of postpartum endometritis for each group. Intraoperatively, all patients who had closed uterine cervical canals underwent a digital opening of the internal and external cervical canal to equalise the groups. All of the participants were checked for endometritis one week after CS at the hospital. Additionally, for the week before and after surgery, C-reactive protein (CRP) and white blood cell (WBC) values were assessed for both groups. Ethics committee approval number: 339. Statistical analysis was performed using R version 3.5.1 (R statistical Software, Institute for Statistics and Mathematics, Vienna, Austria). RESULTS The groups were balanced in terms of the patients' demographic characteristics. There were no significant differences between the two groups according to endometritis rates: 4.6 % in the study group versus 6.4 % in the control group (p > 0.05). The CRP and WBC values before CS were similar in both groups. In the study group, the CRPand WBC values after CS were lower, whereas they were higher in the control group after CS; these differences were significant (p = 0.01 for CRP and p = 0.001 for WBC). CONCLUSION Vaginal disinfection with povidone-iodine solution 10 % before elective CS does not significantly reduce post-caesarean endometritis rates; however, it does significantly reduce inflammatory markers such as CRP and WBC.
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Affiliation(s)
- İhsan Bağlı
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey.
| | - Serhat Ege
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Hanifi Bademkıran
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Mehmet Obut
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Bekir Kahveci
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Gökçe Turan
- Gazi University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Özge Kahramanoğlu
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
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Burke C, Allen R. Complications of Cesarean Birth: Clinical Recommendations for Prevention and Management. MCN Am J Matern Child Nurs 2020; 45:92-99. [PMID: 31804227 DOI: 10.1097/nmc.0000000000000598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increase in severe maternal morbidity and mortality in the United States correlates with a significant rise in U.S. cesarean birth rates from 5.5% in 1970 to a rate of 31.9% of all births in 2018, far beyond the World Health Organization goal of 10% to 15%. Three key contributors to maternal morbidity and mortality related to cesarean birth include complications of hemorrhage, surgical site infection, and venous thromboembolism. All women should be screened for risk factors associated with these major complications during the antepartum, intrapartum, and postpartum period to assure the availability of immediate resources based on the assessment. Implementing evidence-based maternity care safety bundles, toolkits, and protocols to manage these complications can reduce adverse outcomes.
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Affiliation(s)
- Carol Burke
- Carol Burke is a Perinatal Clinical Nurse Specialist, Chicago, IL. The author can be reached via email at Dr. Roma Allen is a Perinatal Network Administrator, Loyola University Medical Center, Maywood, IL
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Eckler R, Quist-Nelson J, Saccone G, Ward H, Berghella V. Adhesive incisional drapes during cesarean delivery for preventing wound infection: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100090. [PMID: 31673692 PMCID: PMC6817601 DOI: 10.1016/j.eurox.2019.100090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the incidence of wound infection after cesarean delivery in procedures conducted using adhesive incisional drapes verses no adhesive incisional drapes. STUDY DESIGN Searches were performed in electronic databases (MEDLINE, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Scopus, OVID, EMBASE, and the PROSPERO International Prospective Register of Systematic Reviews). We included randomized controlled trials comparing adhesive incisional drapes to no adhesive incisional drapes during cesarean delivery. The primary outcome of this meta-analysis was wound infection. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI). RESULTS 52 publications were identified through initial search of databases and two randomized controlled trials were eligible and included in the meta-analysis. Our meta-analysis examined a total of 1943 subjects and showed a statistically significant increase in wound infections in patients in the adhesive incisional drape group when compared to the control group (RR: 1.29, 95% CI: 1.02-1.65). CONCLUSION Adhesive incisional drapes may increase the incidence of wound infections after cesarean delivery. Further studies are necessary to explore this relationship in the setting of current postoperative infection prophylaxis, including broad-spectrum antibiotic coverage, skin preparation and vaginal cleansing.
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Affiliation(s)
- Rebecca Eckler
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Johanna Quist-Nelson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Harvey Ward
- Department of Obstetrics and Gynaecology, Coffs Harbour Health Campus, Coffs Harbour, Australia
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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