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Erritty M, Hale J, Thomas J, Thompson A, Wright R, Low A, Carr M, George R, Williams L, Dumitrescu A, Rees J, Irukulla S, Robin J, Fry CH, Fluck D, Han TS. Evaluation of independent risk factors associated with surgical site infections from caesarean section. Arch Gynecol Obstet 2023; 308:1775-1783. [PMID: 36567354 PMCID: PMC10579128 DOI: 10.1007/s00404-022-06885-7] [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: 07/29/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section). METHODS Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK). RESULTS At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes. CONCLUSIONS High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.
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Affiliation(s)
- Matthew Erritty
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Joann Hale
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - James Thomas
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Thompson
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Ria Wright
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Low
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Megan Carr
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Richard George
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Lisa Williams
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Alexandra Dumitrescu
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jacqui Rees
- Department of Quality, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Shashi Irukulla
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department Acute Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
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Imcha M, Liew NC, McNally A, Zibar D, O’Riordan M, Currie A, Styche T, Hughes J, Whittall C. Single-use negative pressure wound therapy to prevent surgical site complications in high-risk patients undergoing caesarean sections: a real-world study. Int J Qual Health Care 2023; 35:mzad089. [PMID: 37930777 PMCID: PMC10627297 DOI: 10.1093/intqhc/mzad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
Surgical site complications (SSCs), including surgical site infection (SSI), are common following C-sections. Management of the post-operative incision with single-use negative pressure wound therapy (sNPWT) has been shown to reduce the risk of SSC in high-risk individuals. This study explored the outcomes of routine, real-world use of sNPWT in high-risk patients undergoing C-sections. An observational, retrospective in-service evaluation was conducted across eight obstetric centres in the Republic and Northern Ireland. Patients undergoing C-sections were stratified for their risk of developing SSC using commonly known risk factors, including BMI ≥30, smoking, diabetes, and whether the patients had undergone previous C-sections or had a previous history of wound dehiscence. Those at high-risk were treated with sNPWT post-operatively. Data relating to any SSC that developed post-operatively, for up to 30 days, were captured. Data were compared with original research previously published by Wloch et al. (2012). Of 1111 women considered high-risk, 106 (9.5%) went on to develop SSCs, predominantly superficial SSIs. SSCs were associated with extra visits with their general practitioner (GP), outpatient visits, or inpatient hospital stays in 5.7%, 2.4%, and 1.7% of the entire cohort, representing 59.4%, 25.5%, and 17.9% of the 106 patients with SSC. Patients needed on average 1.8 extra GP visits and 0.7 extra outpatient visits. Patients who needed to be readmitted to hospital had an average length of stay of 4 days. In comparison with a previously published cohort, in which sNPWT was not used, we observed a significant reduction in the incidence of SSCs across BMI groups 18.5-24.9 (P = 0.02), 25-29.9 (P = 0.003), and ≥35 kg/m2 (P = 0.04). In those patients who had undergone at least one previous C-section, the rates of complications also reduced (P = 0.006). This analysis provides further justification for using sNPWT to manage surgical incisions in patients considered at high risk of developing post-procedural SSCs, particularly those with a BMI ≥30 or a history of more than one C-section.
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Affiliation(s)
- Mendinaro Imcha
- Obstetrics and Gynaecology, Limerick University Maternity Hospital, Ennis Road, Limerick V94 C566, Republic of Ireland
| | - Nyan Chin Liew
- Obstetrics and Gynaecology, Limerick University Maternity Hospital, Ennis Road, Limerick V94 C566, Republic of Ireland
| | - Arthur McNally
- Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, 274 Grosvenor Road, Belfast BT12 6BA, UK
| | - Davor Zibar
- Obstetrics and Gynaecology, University College Hospital Galway, Newcastle Road, Galway H91 YR71, Republic of Ireland
| | - Mairead O’Riordan
- Obstetrics and Gynaecology, Cork University Maternity Hospital, Wilton Road, Cork T12 YE02, Republic of Ireland
| | - Aoife Currie
- Obstetrics and Gynaecology, Craigavon Area Hospital, 68 Lurgan Road, Craigavon BT63 5QQ, Northern Ireland
| | - Tim Styche
- Global HEOR, Smith & Nephew, 101 Hessle Road, Hull HU3 2BN, UK
| | - Jacqui Hughes
- Global HEOR, Smith & Nephew, 101 Hessle Road, Hull HU3 2BN, UK
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Farid Mojtahedi M, Sepidarkish M, Almukhtar M, Eslami Y, Mohammadianamiri F, Behzad Moghadam K, Rouholamin S, Razavi M, Jafari Tadi M, Fazlollahpour-Naghibi A, Rostami Z, Rostami A, Rezaeinejad M. Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis. J Hosp Infect 2023; 139:82-92. [PMID: 37308061 DOI: 10.1016/j.jhin.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors. METHODS International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I2. RESULTS In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified. CONCLUSION An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.
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Affiliation(s)
- M Farid Mojtahedi
- Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | | | - Y Eslami
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - F Mohammadianamiri
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - S Rouholamin
- Department of Obstetrics and Gynaecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Razavi
- Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - A Fazlollahpour-Naghibi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Z Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - A Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - M Rezaeinejad
- Department of Obstetrics and Gynaecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Plakias S, Moustakidis S, Kokkotis C, Papalexi M, Tsatalas T, Giakas G, Tsaopoulos D. Identifying Soccer Players' Playing Styles: A Systematic Review. J Funct Morphol Kinesiol 2023; 8:104. [PMID: 37606399 PMCID: PMC10443261 DOI: 10.3390/jfmk8030104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Identifying playing styles in football is highly valuable for achieving effective performance analysis. While there is extensive research on team styles, studies on individual player styles are still in their early stages. Thus, the aim of this systematic review was to provide a comprehensive overview of the existing literature on player styles and identify research areas required for further development, offering new directions for future research. Following the PRISMA guidelines for systematic reviews, we conducted a search using a specific strategy across four databases (PubMed, Scopus, Web of Science, and SPORTDiscus). Inclusion and exclusion criteria were applied to the initial search results, ultimately identifying twelve studies suitable for inclusion in this review. Through thematic analysis and qualitative evaluation of these studies, several key findings emerged: (a) a lack of a structured theoretical framework for player styles based on their positions within the team formation, (b) absence of studies investigating the influence of contextual variables on player styles, (c) methodological deficiencies observed in the reviewed studies, and (d) disparity in the objectives of sports science and data science studies. By identifying these gaps in the literature and presenting a structured framework for player styles (based on the compilation of all reported styles from the reviewed studies), this review aims to assist team stakeholders and provide guidance for future research endeavors.
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Affiliation(s)
- Spyridon Plakias
- Department of Physical Education and Sport Science, University of Thessaly, 38221 Trikala, Greece; (S.P.); (T.T.); (G.G.)
| | | | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
| | - Marina Papalexi
- Department of Operations, Technology, Events and Hospitality Management, Manchester Metropolitan University, Oxford Road, Manchester M15 6BH, UK;
| | - Themistoklis Tsatalas
- Department of Physical Education and Sport Science, University of Thessaly, 38221 Trikala, Greece; (S.P.); (T.T.); (G.G.)
| | - Giannis Giakas
- Department of Physical Education and Sport Science, University of Thessaly, 38221 Trikala, Greece; (S.P.); (T.T.); (G.G.)
| | - Dimitrios Tsaopoulos
- Center for Research and Technology Hellas, Institute for Bio-Economy & Agri-Technology, 60361 Volos, Greece;
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Sailakshmi M, Misra S, Hs S, Acharya S, Moharana AK, Ts D. Clinical Equivalence of Monoglyde® and Monocryl® Absorbable Poliglecaprone-25 Sutures: A Single-Blind, Randomized Study. Cureus 2023; 15:e38938. [PMID: 37309337 PMCID: PMC10257932 DOI: 10.7759/cureus.38938] [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: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES Poliglecaprone-25 is a synthetic monofilament suture commonly used for post-cesarean subcuticular skin closure. The present study was designed to assess the effect of subcuticular skin closure using Monoglyde® vs. Monocryl® poliglecaprone-25 absorbable sutures on the risk of wound composite outcomes in the first 30 days post-partum [surgical site infection (SSI), wound dehiscence, hematoma or seroma]. STUDY DESIGN This is a prospective, single-blind, randomized (1:1), multicentric, two-arm study performed between September 2020 and December 2021 at two different centers across India. Women (18-40 years) with a singleton pregnancy requiring cesarean delivery were randomized to Monoglyde® (n=62) or Monocryl® (n=62) suture groups. The primary endpoint is the incidence of wound composite outcomes in the first 30 days post-partum (SSI, wound dehiscence, seroma, or hematoma). In addition, the secondary outcomes, incidence of wound composite outcome at all visits (till four months), suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures (in case not absorbed or infection), operative time, intraoperative suture handling, postoperative pain, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were noted. RESULTS Non-significant difference between the groups regarding demographic characteristics and primary endpoint; the incidence of wound composite outcome was observed. Moreover, no significant difference in suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures, operative time, intraoperative suture handling, pain, return to normal day-to-day activities, modified Hollander cosmesis, and subject satisfaction score were registered between the groups. CONCLUSIONS This study establishes the clinical equivalence of Monoglyde® and Monocryl® poliglecaprone-25 sutures, and both sutures can be used for subcuticular skin closure following cesarean delivery with minimal risk for wound complications.
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Affiliation(s)
- Mpa Sailakshmi
- Obstetrics and Gynecology, RajaRajeswari Medical College and Hospital, Bengaluru, IND
| | - Sukanta Misra
- Obstetrics and Gynecology, Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences, Kolkata, IND
| | - Sathyashree Hs
- Obstetrics and Gynecology, RajaRajeswari Medical College and Hospital, Bengaluru, IND
| | - Soukhin Acharya
- Obstetrics and Gynecology, Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences, Kolkata, IND
| | | | - Deepak Ts
- Clinical Affairs, Healthium Medtech, Bengaluru, IND
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Sekhon JK, Moss C, Watts J. Reducing post-caesarean infection in the Kimberley region of Western Australia: An audit-based observational study. Aust N Z J Obstet Gynaecol 2023; 63:81-85. [PMID: 35315054 DOI: 10.1111/ajo.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The higher burden of post-caesarean infection in the remote Kimberley region of Australia is intimately associated with poorer social determinants of health. This results in a confluence of environmental factors such as overcrowding and limited access to clean water and host factors such as diabetes mellitus and obesity which result in heightened susceptibility and vulnerability to infection. AIM To ascertain infection rates following caesarean section in Broome Hospital, before and after the implementation of evidence-based strategies intended to reduce bacterial load and mitigate the impact of poor underlying social determinants of health. MATERIALS AND METHODS This is a retrospective observational longitudinal audit study including women who underwent caesarean section in Broome Hospital between the time of 1 January 2019 and 1 May 2019 or 1 January 2021 and 1 May 2021. Files and theatre records were audited to determine demographic, surgical and post-partum infection in women who underwent caesarean section at Broome Hospital. The main outcome measure was infection within six weeks post-caesarean section. RESULTS This study found a statistically significant improvement in post-operative infection rates in women who underwent caesarean section at Broome Hospital (41.7% vs 11.6%, P = 0.002). The two groups were statistically similar in background. CONCLUSION The combination of various infection prevention initiatives targeted at reducing infection burden can result in clinical and statistically significant reductions in post-caesarean infections in high-risk populations with poor underlying social determinants of health.
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Affiliation(s)
| | - Charlotte Moss
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jared Watts
- Broome Health Campus, Broome, Western Australia, Australia
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Bocoum A, van Riel SJJM, Traoré SO, Ngo Oum II EF, Traoré Y, Thera AT, Fané S, Dembele BT, Cremers NAJ. Medical-Grade Honey Enhances the Healing of Caesarean Section Wounds and Is Similarly Effective to Antibiotics Combined with Povidone-Iodine in the Prevention of Infections-A Prospective Cohort Study. Antibiotics (Basel) 2023; 12:92. [PMID: 36671293 PMCID: PMC9855001 DOI: 10.3390/antibiotics12010092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Caesarean sections (CS) are becoming increasingly popular. The antibiotic resistance crisis and relentless risk of infections, especially in developing countries, demand alternative treatment options. Medical-grade honey (MGH) exerts antimicrobial and healing properties. This study aims to evaluate the effect of MGH treatment on CS wound healing and postoperative complications when compared to conventional treatment (antibiotics in combination with povidone-iodine). In this prospective cohort study, 766 CS patients were included and evenly divided into two groups. The treatment group (n = 383) received an MGH-based formulation (L-Mesitran Soft) and the control group (n = 383) received antibiotics (Amoxicillin) combined with povidone-iodine. The wound healing time and complication rate were determined for both groups, and subsequently, predisposing factors for complications among the baseline characteristics and non-patient-related parameters were determined. The baseline characteristics were similar for both study groups, supporting a homogenous distribution. Postoperative complications were experienced by 19.3% of the patients in the control group and 18.8% in the treatment (MGH) group. The treatment group experienced significantly more superficial pus discharge than the control group, while the latter experienced significantly more deeper pus discharge. BMI, age, duration of hospitalization, anesthesia, and duration of CS could affect the complication risk. MGH significantly enhanced wound healing until day 42. On average, the healing time with MGH was 19.12 ± 7.760 days versus 24.54 ± 8.168 days in the control group. MGH is a potent alternative treatment to antibiotics and povidone-iodine because while the complication risk is similar, MGH has additional benefits. MGH promotes wound healing and does not bear the risk of resistance.
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Affiliation(s)
- Amadou Bocoum
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Senna J. J. M. van Riel
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, 6162 BG Sittard-Geleen, The Netherlands
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Soumana Oumar Traoré
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Elisabeth Florine Ngo Oum II
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Youssouf Traoré
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Augustin Tioukani Thera
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Seydou Fané
- Gynecology-Obstetrics Department, Faculty of Medicine and Odonto-Stomatology, Center Hospitalier Universitaire (CHU) Gabriel Touré, Bamako, Mali
| | - Bakary Tientigui Dembele
- Department of General Surgery, Faculty of Medicine and Odonto-Stomatology, CHU Gabriel Touré, Bamako, Mali
| | - Niels A. J. Cremers
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- Triticum Exploitatie BV, 6222 NK Maastricht, The Netherlands
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Does a Healthy Lifestyle Lower the Elevated Risk of Obesity Caused by Caesarian Section Delivery in Children and Adolescents? Nutrients 2022; 14:nu14173528. [PMID: 36079786 PMCID: PMC9460904 DOI: 10.3390/nu14173528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Both caesarean section (CS) and lifestyle were linked with child adiposity. This study aimed to investigate whether CS delivery is linked with elevated risk of child adiposity regardless of a healthy lifestyle. Methods: All the subjects in this study came from a baseline survey of a national school-based program on healthy lifestyle interventions against adiposity among Chinese children and adolescents. A questionnaire was used to collect the information on delivery mode and lifestyle. According to the weighted lifestyle score, subjects were categorized into healthy, intermediate, and unhealthy lifestyle. Results: A total of 44,961 children aged 6−18 years were enrolled in the current study. Overall, 41.9% (18,855/44,961) of children were delivered by CS. Compared with children delivered by vaginal delivery, children delivered by CS had a higher adiposity risk (OR = 1.56; 95%CI: 1.46−1.66; p < 0.001) after adjustment for age, sex, region, mother adiposity, ethnicity, and weighted lifestyle factors. Compared with children with a healthy lifestyle, children with an unhealthy lifestyle had a higher risk of child adiposity (OR = 1.31; 95%CI: 1.19−1.44). Children delivered by CS who had an unhealthy lifestyle had a 106% higher (OR = 2.06; 95%CI: 1.79−2.37) risk of child adiposity compared with children delivered by vaginal delivery who had a healthy lifestyle. However, keeping a healthy lifestyle in later life seems not to offset the increased risk of child adiposity caused by CS (OR = 1.59; 95%CI: 1.39−1.82). Conclusions: Both CS and unhealthy lifestyle were linked with child adiposity risk. Keeping a healthy lifestyle did not counteract the elevated risk of child adiposity caused by CS.
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Karaca SY, Adıyeke M, İleri A, İleri H, Vural T, Özmüş DN, Şimşek E, Özeren M. Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers. J Pediatr Adolesc Gynecol 2022; 35:472-477. [PMID: 35031447 DOI: 10.1016/j.jpag.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. DESIGN Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). RESULTS SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR = 2.35; 95% CI, 1.3-4.78), induction of labor (OR = 1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10 g/dl (OR = 2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. CONCLUSIONS BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.
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Affiliation(s)
- Suna Yıldırım Karaca
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Stem Cell, Izmir, Turkey
| | - Mehmet Adıyeke
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Alper İleri
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Hande İleri
- Alsancak State Hospital, Department of Family Medicine, Izmir, Turkey.
| | - Tayfun Vural
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Doğay Nurtaç Özmüş
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Ecem Şimşek
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Mehmet Özeren
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
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10
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Nkurunziza T, Williams W, Kateera F, Riviello R, Niyigena A, Miranda E, Bikorimana L, Nkurunziza J, Velin L, Goodman AS, Matousek A, Klug SJ, Gaju E, Hedt-Gauthier BL. mHealth-community health worker telemedicine intervention for surgical site infection diagnosis: a prospective study among women delivering via caesarean section in rural Rwanda. BMJ Glob Health 2022; 7:bmjgh-2022-009365. [PMID: 35902205 PMCID: PMC9341172 DOI: 10.1136/bmjgh-2022-009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Surgical site infections (SSIs) cause a significant global public health burden in low and middle-income countries. Most SSIs develop after patient discharge and may go undetected. We assessed the feasibility and diagnostic accuracy of an mHealth-community health worker (CHW) home-based telemedicine intervention to diagnose SSIs in women who delivered via caesarean section in rural Rwanda. Methods This prospective cohort study included women who underwent a caesarean section at Kirehe District Hospital between September 2019 and March 2020. At postoperative day 10 (±3 days), a trained CHW visited the woman at home, provided wound care and transmitted a photo of the wound to a remote general practitioner (GP) via WhatsApp. The GP reviewed the photo and made an SSI diagnosis. The next day, the woman returned to the hospital for physical examination by an independent GP, whose SSI diagnosis was considered the gold standard for our analysis. We describe the intervention process indicators and report the sensitivity and specificity of the telemedicine-based diagnosis. Results Of 787 women included in the study, 91.4% (n=719) were located at their home by the CHW and all of them (n=719, 100%) accepted the intervention. The full intervention was completed, including receipt of GP telemedicine diagnosis within 1 hour, for 79.0% (n=623). The GPs diagnosed 30 SSIs (4.2%) through telemedicine and 38 SSIs (5.4%) through physical examination. The telemedicine sensitivity was 36.8% and specificity was 97.6%. The negative predictive value was 96.4%. Conclusions Implementation of an mHealth-CHW home-based intervention in rural Rwanda and similar settings is feasible. Patients’ acceptance of the intervention was key to its success. The telemedicine-based SSI diagnosis had a high negative predictive value but a low sensitivity. Further studies must explore strategies to improve accuracy, such as accompanying wound images with clinical data or developing algorithms using machine learning.
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Affiliation(s)
- Theoneste Nkurunziza
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda .,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Niyigena
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Vascular Surgery, University of Southern California, Los Angeles, California, USA
| | - Laban Bikorimana
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Lotta Velin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Andrea S Goodman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Matousek
- Northwest Heart and Lung Surgical Associates, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Erick Gaju
- eHealth Unit, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Bethany L Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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11
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Gashaw A, Fantu S, Tarekegn M. Factor associated with surgical site infection of women who undergone cesarean section in Hawassa University comprehensive specialized hospital southern Ethiopia, retrospective study design. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Telemedicine for Surgical Site Infection Diagnosis in Rural Rwanda: Concordance and Accuracy of Image Reviews. World J Surg 2022; 46:2094-2101. [PMID: 35665833 DOI: 10.1007/s00268-022-06597-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND In rural Africa where access to medical personnel is limited, telemedicine can be leveraged to empower community health workers (CHWs) to support effective postpartum home-based care after cesarean section (c-section). As a first step toward telemedicine, we assessed the sensitivity, specificity, and interrater reliability of image-based diagnosis of surgical site infections (SSIs) among women delivering via c-section at a rural Rwandan Hospital. METHODS Women ≥18 years who underwent c-section from March to October 2017 at Kirehe District Hospital (KDH) were enrolled. On postoperative day 10 at KDH, participants underwent a physical examination by a general practitioner, who provided a diagnosis of SSI or no SSI. Trained CHWs photographed patients' incisions and the collected images were shown to six physicians, who upon review, assigned one of the following diagnoses to each image: definite SSI, suspected SSI, suspected no SSI, and definite no SSI, which were compared with the diagnoses based on physical exam. We report the sensitivity and specificity and assessed reviewer agreement using Gwet's AC1. RESULTS 569 images were included, with 61 women (10.7%) diagnosed with an SSI. Of the 3414 image-reviews, 49 (1.4%) could not be assigned diagnoses due to image quality. The median sensitivity and specificity were 0.83 and 0.69, respectively. The Gwet's AC1 estimate for binary classification was 0.46. CONCLUSIONS We demonstrate decent accuracy but only moderate consistency for photograph-based SSI diagnosis. Strategies to improve overall agreement include providing clinical information to accompany photographs, providing a baseline photograph for comparison, and implementing photograph-taking processes aimed at improving image quality.
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13
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Prevalence of Surgical Site Infection among Caesarean Section Patients in a Teaching Hospital in Ekiti State, Nigeria: An eight-year review. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Chen Y, Wan J, Zhu Z, Su C, Mei Z. Embedding evidence of early postoperative off-bed activities and rehabilitation in a real clinical setting in China: an interrupted time-series study. BMC Nurs 2022; 21:98. [PMID: 35473628 PMCID: PMC9044807 DOI: 10.1186/s12912-022-00883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients should be encouraged to mobilize with 24 h of caesarean section. However, the time of the first off-bed activity after surgery is usually 24 ~ 48 h in China. Due to the lack of knowledge of early off-bed activities, lack of attention to medical pain, and the absence of systematic evidence for the clinical transformation process. the aim of this study was showed that the application of evidence needs to be embedding in the real setting to construct the localization plan and achieve the effective result. Methods To establish evidence of the benefits of early postoperative off-bed activities on patients’ well-being based on a literature review. An interrupted time series analysis was used to evaluate the effectiveness of the intervention. The first and third periods were both five months (from February 1st, 2019 to January 31st, 2020), with a two-month interrupted time (from July 1st, 2019 to August 31st, 2019). Results Eight clinical practices were retrieved from the literature and incorporated into the intervention. A total of 465 patients were included: 226 patients before and 239 patients after implementing the intervention. The average onset time of postoperative off-bed activities was significantly earlier after the intervention than before the intervention (20.01 vs. 31.89 h after the operation, P < 0.001). The 24-h off-bed rate increased from 30.94% before to 91.21% after the intervention (P < 0.001). The average pain score of patients decreased from 5.23 points before to 3.82 points after the intervention (P = 0.032). The average postoperative hospital stay was shortened from 5.06 days before to 3.51 days after the intervention (P < 0.001). In addition, the incidence rates of postoperative ileus (POI) and infection decreased from 5.38% and 2.65% before to 1.67% and 0.84% after the intervention, respectively (P < 0.001). Conclusions We established an evidence-based nursing intervention. Evaluation of the effect of evidence-based practices should be considered in the clinical setting and include preoperative health education, effective analgesia management, and safety management. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00883-5.
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Affiliation(s)
- Yun Chen
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Wan
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China.
| | - Chunhong Su
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhengrong Mei
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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15
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Onuzo CN, Sefogah PE, Nuamah MA, Ntumy M, Osei MM, Nkyekyer K. SURGICAL SITE INFECTIONS FOLLOWING CAESAREAN SECTIONS IN THE LARGEST TEACHING HOSPITAL IN GHANA. Infect Prev Pract 2022; 4:100203. [PMID: 35265827 PMCID: PMC8898913 DOI: 10.1016/j.infpip.2022.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022] Open
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16
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Ali O, Kassahun D, Rade BK, Atnafu A. Maternal factors are important predictors for surgical site infection following cesarean section in Northwest Ethiopian. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Allen G. A Systematic Review and Meta-Analysis of Preincision Adjunctive Prophylaxis for Cesarean Deliveries. AORN J 2021; 114:643-646. [PMID: 34846748 DOI: 10.1002/aorn.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/09/2022]
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18
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Gomaa K, Abdelraheim AR, El Gelany S, Khalifa EM, Yousef AM, Hassan H. Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study. BMC Pregnancy Childbirth 2021; 21:634. [PMID: 34537018 PMCID: PMC8449867 DOI: 10.1186/s12884-021-04054-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3-20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. METHODS This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. RESULTS The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12-6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11-4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62-3.09), emergency CS (AOR 2.16; 95% CI =1.61-2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67-2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66-2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06-2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02-2.1 3), obesity (AOR 1.34; 95% CI =0.95-1.84), high parity (AOR 1.27; 95% CI = 1.03-1.88), hypertension (AOR 1.19; 95% CI = 0.92-2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94-1.66). The mortality rate due to SSI was 1.33%. CONCLUSIONS The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. REGISTRATION Local ethical committee (Registration number: MOBGYN0040).
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Affiliation(s)
- Khaled Gomaa
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed R Abdelraheim
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Saad El Gelany
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eissa M Khalifa
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman M Yousef
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
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19
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Kvalvik SA, Rasmussen S, Thornhill HF, Baghestan E. Risk factors for surgical site infection following cesarean delivery: A hospital-based case-control study. Acta Obstet Gynecol Scand 2021; 100:2167-2175. [PMID: 34309849 DOI: 10.1111/aogs.14235] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cesarean section is the single most important risk factor for postpartum infection. Where the rest of the world shows increasing trends, the cesarean section rates are low in Norway and risk factors for infection after cesarean section may differ in high and low cesarean section settings. The goal of this study was to examine independent risk factors for surgical site infection after cesarean delivery in a setting of low cesarean section rates. MATERIAL AND METHODS We conducted a hospital-based case-control study at Haukeland University Hospital. We included women who presented to our hospital with surgical site infection after cesarean section during the years 2014-2016 (n = 75). Controls were selected at a ratio of 2:1 (n = 148). Cases and controls were compared with respect to maternal and pregnancy characteristics using uni- and multivariable logistic regression models. Main outcome measures were anticipated risk factors for surgical site infection. RESULTS The occurrence of surgical site infection was 0.4% and 5.4% after elective and emergency cesarean section, respectively. Compared to women without surgical site infection, women with surgical site infection were almost thrice more obese before pregnancy (OR 2.8, 95% CI 1.2-7.0), four times more likely to have preexisting psychiatric conditions (OR 4.4, 95% CI 1.1-17.6), and five times more likely to receive blood transfusion (OR 5.1, 95% CI 1.4-18.8). Signs of infection during labor was a marginally significant risk factor for surgical site infection (OR 2.0, 95% CI 1.0-5.4). CONCLUSIONS Emergency cesarean section was a significant risk factor for surgical site infection. Pregestational obesity, preexisting psychiatric conditions, and blood transfusion during or following delivery, were independent risk factors for surgical site infection. Signs of infection during labor was a marginally significant risk factor. Women with either of these risk factors should be carefully monitored and evaluated for signs of infection in the postpartum period.
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Affiliation(s)
- Sedina Atic Kvalvik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Elham Baghestan
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Narice BF, Almeida JR, Farrell T, Madhuvrata P. Impact of changing gloves during cesarean section on postoperative infective complications: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1581-1594. [PMID: 33871059 DOI: 10.1111/aogs.14161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Brenda F Narice
- Academic Unit of Reproductive and Developmental Medicine, Jessop Wing, University of Sheffield, Sheffield, UK
| | - Joana R Almeida
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Tom Farrell
- Women's Wellness & Research center, Hamad Medical Corporation, Doha, Qatar
| | - Priya Madhuvrata
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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21
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Mekonnen AG, Mittiku YM. Surgical site infection and its association with rupture of membrane following cesarean section in Africa: a systematic review and meta-analysis of published studies. Matern Health Neonatol Perinatol 2021; 7:2. [PMID: 33388090 PMCID: PMC7777267 DOI: 10.1186/s40748-020-00122-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Surgical site infection occurs within 30 days after a surgical procedure and involves the skin, subcutaneous tissue, and soft tissue. Surgical site infection following cesarean section is a common postoperative complication and is associated with maternal morbidity and mortality in resource-limited settings. Even though the proportion of surgical site infection and some risk factors were reported by kinds of literature, varying results were stated across studies. There is also limited knowledge on the association between postpartum surgical site infection and the rupture of membrane. Hence, this systematic review and meta-analysis was designed to estimate the pooled proportion of surgical site infection and its association with rupture of membrane following cesarean section in Africa. Methods Studies published from January 01, 2000 to January 30, 2020 were searched from MEDLINE via PubMed, Scopus, Medscape, Web-science and CINAHL databases to search relevant published articles. We also performed a manual search of reference lists of key articles to retrieve additional relevant articles. Initially, 559 records were identified and 15 studies included in the analysis. The statistical analysis was performed using STATA 11. Heterogeneity between-study was explored by forest plot and inconsistency index (I2). The publication bias was checked by a funnel plot and Egger’s test. Pooled estimates of proportion and odds ratio were calculated by a random-effects model with a 95% confidence interval (CI). Results The overall pooled proportion of surgical site infection following cesarean section was 10.21% (I2 = 86.8, p < 0.000; 95% CI = 8.36, 12.06). The odds of developing surgical site infection among women who had the rupture of membrane before delivery were nearly 6 times higher than those who had not a rupture of the membrane (AOR = 5.65, 95% CI: 3.95–8.07). Conclusions The proportion of surgical site infections following the cesarean section is relatively high. Women who had rupture of the membrane before delivery were more likely to develop surgical site infections following the cesarean section. Due attention should be given to the provision of prophylactic antibiotics that can reduce surgical site infection after cesarean delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-020-00122-2.
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Affiliation(s)
- Alemayehu Gonie Mekonnen
- Department of Nursing, College of Health Science, Debre Berhan University, Po. Box. 445, Debre Berhan, Ethiopia.
| | - Yohannes Moges Mittiku
- Department of Midwifery, College of Health Sciences, Debre Berhan University, Po. Box. 445, Debre Berhan, Ethiopia
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Childs C, Soltani H. Abdominal Cutaneous Thermography and Perfusion Mapping after Caesarean Section: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8693. [PMID: 33238522 PMCID: PMC7700549 DOI: 10.3390/ijerph17228693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a 'surrogate' of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to 'interrogate' the abdominal thermal map. A specific thermal signature ('cold spots') was identified as an early 'flag' for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue 'at risk'. By identifying skin 'hot' or 'cold' spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.
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Affiliation(s)
- Charmaine Childs
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield S10 2BP, South Yorkshire, UK;
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23
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Majlesi M, Montazeri A, Rakhshani F, Nouri-Khashe-Heiran E, Akbari N. 'No to unnecessary caesarean sections': Evaluation of a mass-media campaign on women's knowledge, attitude and intention for mode of delivery. PLoS One 2020; 15:e0235688. [PMID: 32780747 PMCID: PMC7418979 DOI: 10.1371/journal.pone.0235688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Improvement of women’s knowledge and attitude toward vaginal birth is recognized as an important strategy to control caesarean sections (CS) on maternal request. This study aimed to evaluate the effectiveness of a mass-media campaign in improving knowledge, attitude and intention of women for vaginal birth. Methods This was a population-based study carried out in Tehran, Iran. A national ‘No to unnecessary caesarean sections’ campaign was launched in April 2016 and was televised for ten days. A random sample of pregnant women from all defined geographical areas of Tehran were recruited and assessed for knowledge about the benefits of vaginal birth and the risk of CS, attitude and intention toward mode of delivery at two points in time: before and after the campaign. A comparison was made to evaluate outcome measures among those who had seen the campaign and those who had not. Results In all, 37 public and private maternity care centers were selected randomly and 702 eligible pregnant women attending these centers were entered in the study. Pre- and post-intervention data for 466 women were available for analysis. Of these, 194 women indicated that they had seen the campaign and the remaining 272 women said that they had not. A comparison of the outcome measures between the two study groups showed that there were significant differences between those who had seen the campaign and those who had not. Those who had seen the campaign reported increased knowledge, had a more positive attitude and indicated increased behavioral intention toward vaginal birth. Conclusions In general, the findings indicated that the mass-media campaign improved pregnant women’s knowledge, attitude and intention towards vaginal birth. However, the long-term effects of such campaigns need further investigation.
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Affiliation(s)
- Maedeh Majlesi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Science &Culture, ACECR, Tehran, Iran
- * E-mail: (AM); (NA)
| | - Fatemeh Rakhshani
- Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Nouri-Khashe-Heiran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Akbari
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: (AM); (NA)
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Kim HY, Lee D, Kim J, Noh E, Ahn KH, Hong SC, Kim HJ, Oh MJ, Cho GJ. Secular trends in cesarean sections and risk factors in South Korea (2006-2015). Obstet Gynecol Sci 2020; 63:440-447. [PMID: 32689771 PMCID: PMC7393761 DOI: 10.5468/ogs.19212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. METHODS Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. RESULTS Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. CONCLUSION The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.
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Affiliation(s)
- Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Dokyum Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jinsil Kim
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Korea
| | - Ki-Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Caesarean sections are associated with sonographic determined fetal size from the second trimester onwards. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Human birth represents a critical and life-threatening event in the life of mother and child and is therefore of special importance for anthropological as well as public health research.
Study aims: to analyze the association patterns between fetal biometry and delivery modes from the first trimester onwards.
In this electronic medical record-based study, a dataset of 3408 singleton term birth taking place at the Viennese Danube hospital in Austria. was analyzed. Fetal biometry was reconstructed by the results of three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33thweek of gestation. In detail, crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal trans-verse diameter, abdominal sagittal diameter, abdominal circumference, and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. Four delivery modes were compared: spontaneous vaginal birth, instrumental vaginal birth, planned cesarean section and emergency cesarean section.
The total cesarean section rate was 10.2%. Fetal biometry and newborn size differed significantly between the four delivery modes. From the second trimester onward, head circumferences were significantly larger (p=0.005) among fetuses delivered by instrumental delivery or emergency cesarean section than among fetuses delivered by spontaneous vaginal birth. The fetal abdominal dimensions during the third trimester were significantly largest (p=0.001) among fetuses delivered by emergency cesarean section. In comparison to spontaneous vaginal delivery the risk to require instrumental delivery increased significantly with increasing fetal head dimensions at the second (p=0.019) and third trimester(p=0.032) independent of maternal somatic factors. The risk of emergency CS increased significantly with increasing head dimensions (p=0.030) as well as abdominal dimensions (p=0.001) at the third trimester and newborn size (p=0.002), also independently of maternal somatic factors.
In general, larger fetuses are on an increased risk of experiencing instrumental delivery or emergency caesarean section. This association between fetal size and delivery mode is detectable from the second trimester onwards.
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The impact of copper impregnated wound dressings on surgical site infection following caesarean section: a double blind randomised controlled study. Eur J Obstet Gynecol Reprod Biol 2020; 251:83-88. [PMID: 32502772 DOI: 10.1016/j.ejogrb.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the effect of copper impregnated wound dressings on the surgical site infection (SSI) rate following caesarean section (CS). DESIGN Single centre double blind randomised controlled trial. PARTICIPANTS Women aged 18 years or over who had a CS. INTERVENTIONS All women were randomised to receive either a copper-oxide impregnated wound dressing (study group) or a non-copper wound dressing (control group). MAIN OUTCOME MEASURES The primary study outcome was the incidence of SSI within a 30-day period from CS, assessed via a telephone questionnaire. Secondary outcomes were length of hospital stay, and readmission rate. RESULTS 324 women were enrolled in the study of whom 159 were randomised to the study group and 165 to the control group. The follow up rate was 97.5%. A total of 78 women (24.1%) developed an SSI within 30 days following CS; 29 (18.2%) in the study group and 49 (29.7%) controls (P = 0.037, relative risk reduction (RRR) of 38.7%). The incidence of superficial/deep SSI was not significantly different (24.2% vs. 17.6%, P = 0.257), however a significant relative risk reduction of 80.3% for Organ/Space SSI was observed in the study group (12.7% vs. 2.5%, P = 0.002). Length of hospital stay, and readmission rate did not vary significantly between groups. CONCLUSIONS This is the first study to demonstrate a significant reduction in SSI rates following CS with the use of copper impregnated wound dressings. The high SSI rate confirms the importance of new strategies to reduce the infection rate. Copper is a natural remedy which could potentially reduce hospital acquired infections without the use of antibiotics and its associated risks of antibiotic resistance.
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Bolte M, Knapman B, Leibenson L, Ball J, Giles M. Reducing surgical site infections post-caesarean section in an Australian hospital, using a bundled care approach. Infect Dis Health 2020; 25:158-167. [PMID: 32160964 DOI: 10.1016/j.idh.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The past 20 years have seen increasing Caesarean section (CS) rates in Australia. Increasing antenatal morbidity means that post-CS surgical site infection (SSI) is an issue impacting Australian women, mostly low-socioeconomic and regional communities. Recent trends supporting development of evidence-based bundled approaches to SSI reduction, have not proved efficacy nor supported bundle implementation. AIMS This pilot study aimed to develop, implement and assess an evidence-based Caesarean Infection Prevention ("CIP") bundled intervention to reduce post-CS SSI rates in a high risk population. METHODS The study was a pre-post-intervention study, including women undergoing CS at one referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified women who developed a post-CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Data was collected for the subsequent 12 months on women undergoing CS. RESULTS A total of 710 procedures were monitored with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent over time. Post-CS SSI rates significantly reduced post-intervention (5.5% vs. 1.6%, p = 0.007), the greatest benefit in class II and III obese patients (12.2% vs. 2.5%, p = 0.019). Higher hypertension rates (24% vs. 9%, p = 0.01) and lower maternal mean age (27 vs. 30, p = 0.01) were seen in patients with SSI. CONCLUSION The "CIP" bundle effectively reduced post-CS SSIs in a high risk population. Our findings substantiate the need for development and evaluation of multifaceted, evidenced-based interventions to reduce post-CS SSIs. TRIAL REGISTRATION Retrospectively registered. TRIAL REGISTRATION ACTRN12619001001189, July 2019.
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Affiliation(s)
- Michelle Bolte
- Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340.
| | - Blake Knapman
- Wollongong Hospital, 348 Crown Street, Wollongong, NSW, Australia, 2500.
| | - Lilach Leibenson
- Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340.
| | - Jean Ball
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300.
| | - Michelle Giles
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300.
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Abstract
Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case–control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36–1.66), low education level (OR 1.68, 95% CI 1.55–1.84), previous CS (OR 1.27, 95% CI 1.10–1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18–1.88), a long decision–incision time (OR 2.08, 95% CI 1.74–2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10–2.85).
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Prevalence of Early Maternal Complications of Cesarean Section and its Relationship with Body Mass Index in Fatemieh Hospital of Hamadan. PAJOUHAN SCIENTIFIC JOURNAL 2020. [DOI: 10.52547/psj.18.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Fronzo C. Infecciones quirúrgicas postparto: prevención, monitoreo y uso de apósitos con cloruro de dialquilcarbamilo (DACC). J Wound Care 2020; 29:27-31. [DOI: 10.12968/jowc.2020.29.latam_sup_1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sinopsis: La región de América Latina y el Caribe tiene el mayor índice de partos por cesárea del mundo. El dato no es novedoso, pero los riesgos de infección relacionados con esta operación siguen generando preocupación. Sobre todo, en tiempos donde la resistencia a los antibióticos es considerada una de las mayores amenazas para la salud mundial. En Reino Unido, una conferencia sobre prevención de infecciones postparto resaltó esta problemática, presentó las últimas técnicas para el manejo y prevención de infecciones quirúrgicas después de una cesárea, y recomendó diferentes apósitos a la hora de elegir un tratamiento que no favorezca la resistencia a los antibióticos. La necesidad de enfrentar los desafíos que presentan las infecciones postparto, sumada a la importancia de contar con profesionales de la salud entrenados en el cuidado de las heridas y la selección de apósitos, fueron los mensajes claves.
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Affiliation(s)
- Camila Fronzo
- Editora, Journal of Wound Care (JWC) LATAM, Londres, Reino Unido
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Molla M, Temesgen K, Seyoum T, Melkamu M. Surgical site infection and associated factors among women underwent cesarean delivery in Debretabor General Hospital, Northwest Ethiopia: hospital based cross sectional study. BMC Pregnancy Childbirth 2019; 19:317. [PMID: 31464598 PMCID: PMC6716814 DOI: 10.1186/s12884-019-2442-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background Cesarean section rates have been increasing dramatically during the past three decades and surgical site infections are becoming a leading cause of morbidity and mortality among women undergoing cesarean deliveries. However there is lack of sound evidence on both the magnitude of the problem and the associated factors in developing countries including Ethiopia. The purpose of this study was to assess proportion of surgical site infection and associated factors among women undergoing cesarean delivery in Debretabor General Hospital. Methods An institution based cross sectional study was conducted from May to December / 2017. All women delivered by cesarean section in Debretabor General Hospital during data collection period were our study population. Data were collected using Pre-tested, semi-structured questionnaire/ data extraction tool and post discharge phone follow up and analyzed using SPSS version 20. Logistic regression model was used to determine the association of independent variables with the outcome variable and odds ratios with 95% confidence interval were used to estimate the strength of the association. Results Proportion of surgical site infection among cesarean deliveries was about 8% (95%Cl: 5.4, 11.6). Pregnancy induced hypertension (AOR = 4.75, 95%CI: 1.62, 13.92), chorioaminitis (AOR = 4.37, 95%CI: 1.53, 12.50), midline skin incision (AOR = 5.19, 95% CI: 1.87, 14.37 and post-operative hemoglobin less than 11 g/deciliter (AOR = 5.28, 95%CI: 1.97, 14.18) were significantly associated with surgical site infection. Conclusions Pregnancy induced hypertension, chorioaminitis, midline skin incision and post-operative hemoglobin of less than 11 g/deciliter were independent factors associated with surgical site infection. Cesarean deliveries with concomitant pregnancy induced hypertension, chorioaminitis and post-operative anemia needs special care and follow up until surgical site infection is ruled out. It is also advisable to reduce generous midline skin incision and better replaced with pfannensteil incision.
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Affiliation(s)
- Mihretu Molla
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kiber Temesgen
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Seyoum
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengstu Melkamu
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Saeed KB, Corcoran P, Greene RA. Incisional surgical site infection following cesarean section: A national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 240:256-260. [PMID: 31344664 DOI: 10.1016/j.ejogrb.2019.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the rate and associated risk factors for incisional surgical site infection following cesarean section in Ireland. STUDY DESIGN This study was a retrospective population-based cohort study, conducted using the Hospital In-Patient Enquiry database (HIPE) for the period 2005-2016. All women who underwent cesarean section between 2005 and 2016 in Ireland were included. Potential risk factors for incisional surgical site infection were selected based on the existing literature and their availability within the HIPE database. The risk of incisional surgical site infection following cesarean section with exact Poisson 95% confidence intervals were reported. Multivariable Poisson regression included all potential risk factors simultaneously. Risk ratios are reported with their 95% confidence intervals and P-values. RESULTS There were 802,182 deliveries during the study period, 219,859 of which (27.4%) were by cesarean section. There were 1396 cases of incisional surgical site infection, a risk of 0.63% (95% confidence interval: 0.60-0.67%). Public patients had approximately 20% higher risk and the risk was almost 40% higher among women aged over 35 years compared with those aged under 25 years. Most notable, related to the morbidities assessed, was the twofold increased risk of incisional surgical site infection associated with pre-existing diabetes and with urinary tract infection in pregnancy. Premature rupture of membranes, pyrexia during labour and postpartum haemorrhage each increased risk by 40-60%. Hematoma of a cesarean section wound remained by far the strongest risk factor for incisional surgical site infection. CONCLUSION Of all the risk factors we studied, hematoma had the strongest association with development of incisional surgical site infection. Of all women birthing by cesarean section in Ireland during 2005-2016, 25% had at least one of the risk factors identified by our study. Approximately 40% of the incisional surgical site infection cases came from this 25%. This might suggest that a universal approach to reducing risk of surgical site infection is warranted.
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Affiliation(s)
- Khalid Bm Saeed
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
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Gao Y, Tang Y, Tong M, Du Y, Chen Q. Does attendance of a prenatal education course reduce rates of caesarean section on maternal request? A questionnaire study in a tertiary women hospital in Shanghai, China. BMJ Open 2019; 9:e029437. [PMID: 31230031 PMCID: PMC6596961 DOI: 10.1136/bmjopen-2019-029437] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Caesarean section rates have significantly increased worldwide. China has a caesarean rate of 46%, with a moderate contribution of caesarean section on maternal request. In this study, we investigated the association between maternal characteristics, attendance at a prenatal education course and caesarean section on maternal request. DESIGN Questionnaire study. SETTING Tertiary hospital in China. SAMPLE 564 questionnaires. METHODS On postpartum day 42, questionnaire data were collected. Data including age, parity, gravida, delivery mode, educational level, residence status, living condition and attendance of prenatal education course were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Factors associated with caesarean section on maternal request. RESULTS 46% of women were delivered by caesarean section on maternal request. Maternal age and residence status were all significantly associated with having a caesarean section on maternal request. The OR of an increase in caesarean section on maternal request in women over 30 years was 2.42 (95%confidence limits 1.597 to 3.666), compared with women under 30 years. 75% more women who resided in Shanghai had caesarean section on maternal request, compared with women who resided outside of Shanghai. However, there was a significant reduction (35%) in the number of caesarean sections on maternal request in women who attended a prenatal education course (p=0.029). There was no significant association between attendance of a prenatal education course and the other maternal characteristics studied. CONCLUSION Maternal age is associated with an increased risk of caesarean section on maternal request. For women of all age, attendance of a prenatal education course significantly reduced the rate of caesarean section on maternal request. Our data suggest that promotion of a prenatal education course is an important tool in China to reduce the rate of caesarean section.
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Affiliation(s)
- Yifei Gao
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Yunhui Tang
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, UK
| | - Yan Du
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
- Obstetrics & Gynaecology, University of Auckland, Auckland, New Zealand
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Nkurunziza T, Kateera F, Sonderman K, Gruendl M, Nihiwacu E, Ramadhan B, Cherian T, Nahimana E, Ntakiyiruta G, Habiyakare C, Ngamije P, Matousek A, Gaju E, Riviello R, Hedt-Gauthier B. Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda. Br J Surg 2019; 106:e121-e128. [PMID: 30620071 PMCID: PMC7938824 DOI: 10.1002/bjs.11060] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/30/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
Background There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda. Methods Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection. Results Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI. Conclusion The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.
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Affiliation(s)
| | - F Kateera
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - K Sonderman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Gruendl
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Public Health, Technical University Munich, Munich, Germany
| | - E Nihiwacu
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - B Ramadhan
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - T Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - E Nahimana
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | | | | | | | - A Matousek
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Gaju
- Ministry of Health Kigali, Rwanda
| | - R Riviello
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - B Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Risk factors for surgical site infection after cesarean delivery: A case-control study. Am J Infect Control 2019; 47:164-169. [PMID: 30253904 DOI: 10.1016/j.ajic.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The cesarean delivery (CD) rate is increasing worldwide. Surgical site infection (SSI) incidence is likely to follow an upward trajectory. We examined the incidence and risk factors for SSI after CD. METHODS A case-control study of women who had a lower-segment CD during the study period was performed at Ireland's Cork University Maternity Hospital. Cases were patients who presented to the hospital with SSI and who met the criteria of the U.S. Centers for Disease Control and Prevention. Controls were randomly selected from the discharge register of CDs at a ratio of 2:1. Data were extracted from the medical records. A multivariable stepwise logistic regression model approach was used, and the results were expressed as adjusted odds ratios (aORs). RESULTS The SSI rate was 2%. The greatest contribution to risk of SSI was associated with maternal obesity (aOR, 4.76; 95% confidence interval [CI], 2.00-11.32) and hypertensive disorders (aOR, 6.67; 95% CI, 1.54-28.99]. There was also an increased risk for women who underwent an emergency CD (aOR, 3.50; 95% CI, 1.09-11.30), for women who had ≥5 vaginal examinations (aOR, 3.24; 95% CI, 0.92-11.41), and for women without hypertensive disorders who delivered a baby weighing <3,500 g (aOR, 2.18; 95% CI, 1.08-4.37). CONCLUSIONS Obesity, hypertensive disorders, emergency CD, and multiple vaginal examinations were independent risk factors for SSI after CD.
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Tan WS, Arulselvan P, Ng SF, Mat Taib CN, Sarian MN, Fakurazi S. Improvement of diabetic wound healing by topical application of Vicenin-2 hydrocolloid film on Sprague Dawley rats. Altern Ther Health Med 2019; 19:20. [PMID: 30654793 PMCID: PMC6337851 DOI: 10.1186/s12906-018-2427-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/27/2018] [Indexed: 12/30/2022]
Abstract
Background Impaired wound healing is a debilitating complication of diabetes that leads to significant morbidity, particularly foot ulcers. The risk of developing diabetic foot ulcers for diabetic patients is 15% over their lifetime and approximately 85% of limb amputations is caused by non–healing ulcers. Unhealed, gangrenous wounds destroy the structural integrity of the skin, which acts as a protective barrier that prevents the invasion of external noxious agents into the body. Vicenin-2 (VCN-2) has been reported to contain prospective anti-oxidant and anti-inflammatory properties that enhance cell proliferation and migration. Sodium Alginate (SA) is a natural polysaccharide that possesses gel forming properties and has biodegradable and biocompatible characteristics. Therefore, the objective of this study is to evaluate the effect of SA wound dressings containing VCN-2 on diabetic wounds. Methods Wounds were inflicted in type-1 diabetic-streptozotocin (STZ) induced male Sprague Dawley rats. Subsequently, relevant groups were topically treated with the indicated concentrations (12.5, 25 and 50 μM) of VCN-2 hydrocolloid film over the study duration (14 days). The control group was treated with vehicle dressing (blank or allantoin). Wounded tissues and blood serum were collected on 0, 7 and 14 days prior to sacrifice. Appropriate wound assessments such as histological tests, nitric oxide assays, enzyme-linked immunosorbent assays (ELISA) and immunoblotting assays were conducted to confirm wound healing efficacy in the in vivo model. One-way Analysis of Variance (ANOVA) was used for statistical analysis. Results Results showed that hydrocolloid film was recapitulated with VCN-2 enhanced diabetic wound healing in a dose-dependent manner. VCN-2 reduced pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α), mediators (iNOS and COX-2), and nitric oxide (NO) via the NF-κB pathway. Data suggests that the VCN-2 film facilitated healing in hyperglycemic conditions by releasing growth factors such as (VEGF and TGF-β) to enhance cell proliferation, migration, and wound contraction via the VEGF and TGF-β mechanism pathways. Conclusions This study’s findings suggest that VCN-2 may possess wound healing potential since topical treatment with VCN-2 hydrocolloid films effectively enhanced wound healing in hyperglycemic conditions.
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Yassir S, Al-Rubaey B. Frequency of cesarean sections in female physicians and medical students in Babylon governorate. MEDICAL JOURNAL OF BABYLON 2019. [DOI: 10.4103/mjbl.mjbl_69_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kirchengast S, Hartmann B. Recent Lifestyle Parameters Are Associated with Increasing Caesarean Section Rates among Singleton Term Births in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:E14. [PMID: 30577604 PMCID: PMC6338883 DOI: 10.3390/ijerph16010014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
Caesarean section (CS) rates are increasing in many parts of the world, recently reaching about 20% worldwide. The postmodern lifestyle characteristics, obesity and delayed childbirth, have been put forward as the main reasons for high CS rates. The present study tests the association patterns between lifestyle parameters and delivery mode on a data set of 3786 births in Vienna between 2005 and 2013. The focus is exclusively on singleton term births. As well as maternal age, prepregnancy weight status, maternal body height and gestational weight gain, newborn size (birth weight, birth length, and head circumference), Apgar scores and child presentation were recorded. Planned as well as emergency CS rates increased significantly (p < 0.0001) with increasing maternal age and decreasing maternal body height. Emergency CS rates, however, increased significantly with increasing maternal prepregnancy weight status and gestational weight gain. An especially high risk of emergency CS occurred among four groups of mothers: those older than 40 years (OR = 2.68; 95% CI 1.87⁻3.86), those who were obese (OR = 1.44; 95% 1.15⁻1.81), those experiencing a gestational weight gain above 15 kg (OR = 1.32; 95% CI 1.13⁻1.54), and those shorter than 160 cm (OR = 1.216; 95% CI 1.02⁻1.45). Emergency CS rates were significantly higher among low-weight newborns (<2500 g) and macrosome newborns (>4000 g) than among normal-weight newborns. Furthermore, breech presentation was associated with an increased risk of caesarean delivery (OR 6.97; 95% CI 6.09⁻7.96). Logistic regression analyses reveal that maternal age, maternal body height, prepregnancy weight status, gestational weight gain, birth weight, newborn head circumference and child presentation show an independent, highly significant association with caesarean delivery. We conclude that maternal and newborn characteristics typical of recent lifestyle patterns, such as advanced maternal age, obesity, increased gestational weight gain and increased newborn size, are highly significantly associated with increased emergency CS rates. Moreover, maternal shortness and breech presentation are risk factors for emergency CS.
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Affiliation(s)
- Sylvia Kirchengast
- Department of Anthropology, University of Vienna, A-1090 Vienna, Austria.
| | - Beda Hartmann
- Clinic for Gynaecology and Obstetrics, Danube Hospital, A-1220 Vienna, Austria.
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Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L, Nelson G. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am J Obstet Gynecol 2018; 219:523.e1-523.e15. [PMID: 30240657 DOI: 10.1016/j.ajog.2018.09.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 01/09/2023]
Abstract
This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30-60 minutes before skin incision) to hospital discharge. The literature search (1966-2017) used Embase and PubMed to search medical subject headings that included "Cesarean Section," "Cesarean Section," "Cesarean Section Delivery" and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30-60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation, ), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.
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Toba M, Moriwaki M, Oshima N, Aiso Y, Shima M, Nukui Y, Obayashi S, Fushimi K. Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery. J Obstet Gynaecol Res 2018; 44:1800-1807. [PMID: 30051538 DOI: 10.1111/jog.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/25/2018] [Indexed: 12/13/2022]
Abstract
AIM We modified the antimicrobial prophylaxis of surgical site infection (SSI) according to the guidelines of the Japanese Society of Chemotherapy and Japan Society of Infectious Diseases (hereinafter referred to as optimization) and measured outcomes. METHODS From April 2016 to March 2017, we performed cesarean section and open hysterectomy with optimization, and compared the outcome to that of surgery performed without optimization between April 2014 and March 2016. We measured the rates of antibiotic discontinuation, appropriate antibiotic selection, SSI incidence, resumption of antibiotic therapy and fever incidence, as well as the length of postoperative hospital stay and medical expenses for antibiotics to evaluate the appropriateness and outcomes of antibiotic prophylaxis. RESULTS Optimization resulted in a change in the method of selecting antibiotics for cesarean section, but there was no change in SSI incidence rate (0.74% vs 0.0%, P = 0.36). Optimization reduced the use of antibiotics and medical expenses of hysterectomy (median reduction of 50% and 78% for hysterectomy without or with lymphadenectomy, respectively). However, there was no change in outcome regarding SSI incidence (5.7% vs 0.0%, P = 0.11 and 7.8% vs 9.5%, P = 0.77, respectively). CONCLUSION Appropriate use of antibiotics according to guidelines reduced antibiotic dose and medical expenses, but there was no change in outcome regarding SSI incidence rate. These findings suggested that implementation of dosing regimens according to the guidelines would be useful to reduce antibiotic medicine costs and prevent resistant bacteria and complications associated with antibiotics.
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Affiliation(s)
- Mikayo Toba
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan.,Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsuko Moriwaki
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Oshima
- Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshibumi Aiso
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mari Shima
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Nukui
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Obayashi
- Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
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Chang KM, Lee MH, Lin HH, Wu SL, Wu HC. Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome? Neurourol Urodyn 2018; 37:2638-2644. [PMID: 29717503 DOI: 10.1002/nau.23704] [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: 02/12/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS A high number of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) have a history of pelvic surgeries, and cesarean section is one of the most common pelvic surgeries in women. This study aimed to investigate if cesarean section increases the risk of IC/PBS. METHODS Women who exclusively gave birth through cesarean section or vaginal delivery were identified from a nationwide database between 2002 and 2013. All were followed up during the study period to detect the event of IC/PBS. The IC/PBS hazard ratio (HR) in the cesarean cohort was compared with the vaginal delivery cohort with and without matching for confounding factors. RESULTS The unmatched group included 22 158 cesarean deliveries and 40 214 vaginal deliveries. The IC/PBS HR in the cesarean cohort compared with that in the vaginal delivery cohort was 1.370 (95% confidence interval [CI], 0.903-2.079; P = 0.139). In the matched group, 8368 women were matched in each cesarean and vaginal delivery cohort using propensity scores for age and comorbidities. The IC/PBS HR was 0.725 (95%CI, 0.358-1.471; P = 0.373). Both HRs in these two groups were not significantly different. The incidence density of IC/PBS in delivered women, non-delivery women, and the general female population were not significantly different either (0.310, 0.255, and 0.292 per 1000 person-years, respectively; P = 0.549). CONCLUSIONS The risk of IC/PBS was not different between cesarean and vaginal delivery after controlling the confounding factors in this cohort study. Cesarean section has no causal effect on IC/BPS. Furthermore, delivery was not a risk factor for IC/PBS.
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Affiliation(s)
- Kun-Min Chang
- Department of Obstetrics and Gynecology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Ming-Huei Lee
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China.,Department of Urology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China
| | - Hsuan-Hung Lin
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Shang-Liang Wu
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Huei-Ching Wu
- Department of Urology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China
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Marchocki Z, Vinturache A, Collins K, O' Reilly P, O'Donoghue K. Amniotic fluid C-reactive protein as a predictor of infection in caesarean section: a feasibility study. Sci Rep 2018; 8:6372. [PMID: 29686267 PMCID: PMC5913132 DOI: 10.1038/s41598-018-24569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the feasibility of maternal C-reactive protein (CRP) in amniotic fluid (AF) as a predictor of post-partum infection in women who undergo emergency or elective caesarean section (CS). AF bacterial culture and levels of hs-CRP in maternal serum and AF were evaluated in Day 0 and three days thereafter (Day 3) in 79 women undergoing CS. Univariate analyses assessed the clinical and demographic characteristics, whereas the ROC curves assessed the feasibility of hs-CRP as marker of inflammation in women who undergo CS. There was no difference in AF, Day 0, and Day 3 serum hs-CRP levels between women with sterile compared to those with bacterial growth in AF. Among women with positive AF cultures, AF and Day 0 serum hs-CRP levels were higher in women who underwent emergency compared to those who had elective CS (p = 0.04, and p = 0.02 respectively). hs-CRP in Day 0 and Day 3 serum but not in AF has a fair predictor value of infection in emergency CS only (AUC 0.767; 95% CI 0.606-0.928, and AUC 0.791; 95% CI 0.645-0.036, respectively). We conclude that AF hs-CRP is not feasible in assessing the risk of post-cesarean inflammation or infection.
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Affiliation(s)
- Zbigniew Marchocki
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Angela Vinturache
- John Radliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Kevin Collins
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Paddy O' Reilly
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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