Caesarean Section In Obese Women Research Articles

Obesity at term: What to consider? How to deliver?

Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.

Combination Vs Single Antibiotics for Prevention of Surgical Site Infection during Caesarean Section in Obese Women: Randomized Controlled Trial

Combination Vs Single Antibiotics for Prevention of Surgical Site Infection during Caesarean Section in Obese Women: Randomized Controlled Trial

Expression of Concern: Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial

This article refers to:Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial

Role of saline irrigation of subcutaneous tissue to reduce wound infection in cesarean section in obese women

Role of saline irrigation of subcutaneous tissue to reduce wound infection in cesarean section in obese women

Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study.

BackgroundObesity is increasing in Sweden and is also of huge global concern. Obesity increases the risk of complications during pregnancy and the need for the induction of labor. Induction of labor increases the number of complications during delivery, leading to women with more negative birth experience. This study investigated how maternal body mass index (BMI) during antenatal care enrollment affects labor outcomes (proportion of cesarean section at induction of labor).MethodThis was a retrospective cohort study of 3772 women with mixed parity and induction of labor at Soderhospital, Stockholm, in 2009–2010 and 2012–2013. The inclusion criteria were simplex, ≥34 gestational weeks, cephalic presentation and no previous cesarean section. The women were grouped according to BMI, and statistical analyzes were performed to compare the proportion of cesarean sections after induction of labor. The primary outcome was the proportion of cesarean section after induction of labor divided by group of maternal BMI. The secondary outcomes were postpartum hemorrhage >1000 ml, time of labor, fetal outcome data, and indication for emergency cesarean section.ResultThe induction of labor in women with a high BMI resulted in a significantly increased risk of cesarean section, with 18.4–24.1% of deliveries, depending on the BMI group. This outcome persisted after adjustment in women with BMI 25–29.9 (aOR 1.4; 95% CI; 1.1–1.7) and BMI 30–34.9 (aOR 1.5; 95% CI; 1.1–2.1). There was also a significantly higher risk for CS among primiparous women (aOR 3.6; 95% CI; 2.9–45) and if the newborn weighted ≥ four kilos (aOR 1.6; 95% CI; 1.3–2.0).ConclusionOur findings show that a higher BMI increased the risk of cesarean section after induction of labor in the groups with BMI 25–34.9. Parity seems to be the strongest risk factor for CS regardless other variables.

A guide to caesarean wound healing

A guide to caesarean wound healing

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women.

(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.

The association of skin incision placement during cesarean delivery with wound complications in obese women: a systematic review and meta-analysis

Objective To determine the risk of wound complications by skin incision type in obese women undergoing cesarean delivery. Data sources: Electronic databases (MEDLINE, Scopus, and Ovid) were searched from their inception through August 2018. Methods of study selection: We included all randomized controlled trials and cohort studies reporting the placement of skin incision during cesarean section in obese women, defined as those with BMI ≥30 kg/m2. Studies were included if they compared one placement of skin incision with a different one as comparison group. The primary outcome was incidence of wound complications, while secondary outcomes included wound infection, hematoma, seroma, postpartum hemorrhage, and endometritis. Demographics and outcomes for each individual study identified were reported as part of the review. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI). Sub-group analyses (vertical versus Pfannenstiel) were also reported. Tabulation, integration and results: Seventeen studies (including 3 RCTs; 8960 participants among the 15 non-overlapping studies) were included in the systematic review. Vertical incisions were associated with a relative risk of 2.07 (95% CI1.61–2.67) for wound complications compared to transverse incisions, however significant possible confounders were present. Studies were mildly-moderately heterogeneous (I 2 44.81%, 95% CI 0.00–71.85%) with varying definitions of obesity and wound complications. High transverse incisions (3 studies, 218 participants) trend toward a lower risk of wound complications compared to low transverse incisions (RR 0.338, 95% CI 0.114–1.004). Conclusions Vertical incisions may be associated with an increased risk for wound complications compared to transverse incisions for cesarean delivery in obese women. Randomized controlled trials are needed to evaluate optimal cesarean skin incisions for these women.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Prophylactic Incisional Negative Pressure Wound Therapy Reduces the Risk of Surgical Site Infection After Caesarean Section in Obese Women: A Pragmatic Randomized Clinical Trial

(BJOG. 2019;126:628–625) About 10% of obese patients experience surgical site infection after cesarean delivery, despite recognized interventions such as prophylactic antibiotics and antiseptic skin preparation to help reduce this maternal risk. An alternative to the standard postoperative dressing (SPD) that has been shown to reduce the risk of surgical site infections in nonobstetric patients is incisional negative pressure wound therapy (iNPWT). There are only a few studies that have focused on this intervention in obstetric patients undergoing cesarean delivery. This study aimed to assess the effectiveness of prophylactic iNPWT on obese patients after cesarean delivery.

Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial sequential analysis

Objective Current evidence for negative pressure wound therapy (NPWT) on surgical site infection (SSI) and wound complications in cesarean section is conflicting. The objective of this study was to evaluate the efficacy of prophylactic NPWT for preventing SSI and other wound complications in obese women undergoing cesarean section (CS). Methods We systematically searched PubMed, Embase, the Cochrane Library and clinicaltTrial.gov to identify randomized controlled trials (RCTs) that compared NPWT with standard dressing for cesarean section. The primary outcome was SSI. Secondary outcomes were overall wound complications and hospital readmission. Risk ratio (RR) with 95% confidence intervals (CIs) was calculated using random-effects models. Review Manager 5.3 was applied to analyze the collected data. Results Eight RCTs involving 1972 patients were included in this meta-analysis. The pooled results showed that the risk of SSI was significantly lower with the use of NPWT when compared with standard dressing (RR = 0.68, 95%CI = 0.51–0.90, p = .008). However, there was no difference in overall wound complications (RR = 0.93, 95%CI = 0.74–1.17, p = 0.52) and hospital readmission (RR = 1.03, 95%CI = 0.67–1.60, p = .89) between two groups. Current evidence was not confirmed by trial sequential analysis. Conclusion On the basis of our findings, NPWT decreases the risk of SSI after cesarean section in obese women after CS, despite this approach does not reduce the overall wound complications and hospital readmission. However, further RCTs are needed to make conclusive evidence.

Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women: a trial-based economic evaluation.

To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. A cost-effectiveness analysis conducted alongside a clinical trial. Five obstetric departments in Denmark. Women with a pregestational body mass index (BMI) ≥30 kg/m2 . We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m2 . Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m2 . Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.

Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial.

ObjectiveTo evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section.DesignMulticentre randomised controlled trial.SettingFive hospitals in Denmark.PopulationObese women (prepregnancy body mass index (BMI) ≥30 kg/m2) undergoing elective or emergency caesarean section.MethodThe participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention‐to‐treat. Blinding was not possible due to the nature of the intervention.Main outcome measuresThe primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health‐related quality of life.ResultsIncisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30–0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups.ConclusionProphylactic use of incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women giving birth by caesarean section.Tweetable abstract RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.

Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial

Objective: To compare the interrupted subcuticular skin closure with continuous one in obese women undergoing cesarean delivery.Materials and methods: A randomized controlled study conducted on 169 obese women with term uncomplicated singleton pregnancy who underwent elective cesarean delivery. They were randomized to either skin closure through continuous subcuticular sutures using vicryl 3/0 or interrupted subcuticular suturing using vicryl 3/0. The primary outcome parameter was occurrence of wound infection. Secondary outcomes included other skin complications, postoperative pain, operative duration and hospital stayResults: There was a statistically higher number of cases with wound hematoma (20 vs. 10, p = .04), infection (30 vs. 15, p = .008) and those who needed reclosure of wound (8 vs. 0, p = .004) in the continuous when compared to women in the interrupted subcuticular group, respectively. Healing with secondary intension was significantly higher in women in the continuous subcuticular group (52 vs. 26, respectively, p < .001). The number of cases with wound seroma and keloid formation was not statistically different between the two groups (25 vs. 19, p = .272 and 12 vs. 5, p = .069 in the continuous vs. interrupted groups, respectively). The duration of CS was longer in those who underwent interrupted closure when compared to continuous ones. However, that was statistically insignificant (40.95 + 6.376 vs. 37.05 + 6.455, p = 0.14).Conclusions: Most surgical wound complications were reduced if skin closure with continuous subcuticular sutures is replaced with interrupted one.

Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy

BackgroundNegative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness. ObjectiveTo evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial. MethodsAn economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained. ResultsPatients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates. ConclusionsNPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds. Australian and New Zealand trial registration numberACTRN12612000171819.

Obesity and the challenges of caesarean delivery: Prevention and management of wound complications

Caesarean section in obese patients is associated with an increased risk of surgical wound complications, including haematoma, seroma, abscess and dehiscence. This review focusses on the available strategies to decrease wound complications in this population, and on the clinical management of these situations. Appropriate dose of prophylactic antibiotics, closure of the subcutaneous tissue, and avoidance of subcutaneous drains reduce the incidence of wound complications associated with caesarean section in obese patients. For treatment of superficial wound infection associated with dehiscence, there are data from general surgery patients to suggest that the use of vacuum-assisted devices leads to faster healing and that surgical reclosure is preferable to healing by secondary intention, when there are no signs of ongoing infection. There is a need for stronger evidence regarding the prevention and management of wound complications for caesarean section in obese women.

504: Risk and determinants of caesarean section in obese women in France in 2010

504: Risk and determinants of caesarean section in obese women in France in 2010

Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing

To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing. The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES). A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II. Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.

Complications associated with delivery by caesarean section: is there a difference by body mass index?

IntroductionEvidence suggests that delivery by caesarean section in obese women (body mass index (BMI) ≥ 30kg/m2) carries a higher risk of postoperative complications.AimThis study tested the hypothesis that overweight (BMI...