الفهرس 
Cesarean SectionOnly 14 pages are availabe for public view
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Abstract
Cesarean birth is one of the most common laparotomies done in the world today, thus any useful refinement in the operative technique, however minimal, is likely to yield substantial benefits. The surgical technique for cesarean birth has changed from time to time, from surgeon to surgeon and these changes were involved both of the uterine and the skin incisions (Cunningham et al., 2002)
Caesarean section is a common operation with no agreed standard on operative techniques and materials to use. The skin layer can be repaired by sub cuticular stitch immediately below the skin layer, an interrupted stitch or with skin staples. A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women (Alderdice et al., 2010).
Surgical site infection is a common complication of surgery. Infection has always been a feature of modern surgery and continues to be a significant problem for health care practitioners across the world. Surgical site infection is a common and major cause of postoperative morbidity. Its morbidities range from delayed healing to systemic sepsis.
Factors known to be associated with poor wound healing include obesity, diabetes mellitus, anemia, malnutrition, choice of suture material and surgical techniques (Gall, 1988).
Although several factors contribute to cesarean wound complications, the optimal method of skin closure to minimize these complications is unknown.
whereas two large-scale international trials are underway comparing different techniques of cesarean delivery, none is evaluating methods of skin closure.
The aim of this study is to determine the surgical site infection rate and patient satisfaction in obese patients undergoing cesarean section using subcuticular suture compared to interrupted mattress suture in skin closure.
There were 5 RCT comparing subcuticular suture with staples (Frishman et al., 1997), (Gaertner et al., 2008), (Rousseau et al., 2009), (Cromi et al., 2010), (Basha et al., 2010). Primary outcomes were rates of wound dehiscence (separation) and a composite wound complication rate. Secondary outcomes were patient satisfaction, operating time, and postoperative pain. A total of 877 women from 5 trials were included. Both wound separation (pooled odds ratio, 4.01; P_.0001) and composite wound complication (pooled odds ratio, 2.11; P _ .003) rates were higher with staples. The use of staples reduced operating time (weighted mean difference, –5.05 minutes; P _ .021).
This is a randomized controlled trial conducted in Ain-Shams University Maternity Hospital. It included 130 pregnant women who underwent elective Cesarean section.
The patients included were any female in childbearing period, planned for elective Cesarean section and Obese (BMI ≥ 30 Kg/m2).
Excluding patients who have concurrent overt infection (e.g. chorioamnionitis, pyelonephritis or chest infection), Women who have intraoperative events that may themselves predispose to perioperative infection (e.g. bowel injury, operative time more than 90 minutes, major blood loss) and Women who have hemoglobin less than 10g/dl, pre-eclampsia, rupture of membranes more than 12 hours, immunocompro-mised.
The participants were divided in two groups: group I include 67 women and had there skin closed with interrupted mattress suture, group II include 63 women and had there skin closed with subcuticular suture.
To our knowledge no other study evaluated the role of skin closure methods in the incidence of SSI in obese patients. In the current study all Cesarean section procedures were performed by surgeons who at least have a 2-year experience in practicing Cesarean sections. Antibiotic prophylaxis was given, as two intravenous doses of broad-spectrum penicillins [after clamping of the umbilical cord and 12 hours postoperatively]. Oral antibiotic of the same group was then started for 3-5 days. Any scar of previous cesarean section was removed. After closure of the fascial layer, subcutaneous tissue was closed if it was deeper than 2 cm. Subcutaneous drains were not left in any of the included women. Skin was closed by the closure method according to the allocated group i.e. interrupted mattress stitches using non-absorbable polypropylene 1 in group I and subcuticular stitches using non absorbable polypropylene 2-0 in group II. Wound was uncovered 24 hours postoperatively, and dressed, while uncovered, with alcohol 70% antiseptic solution for 7 days. The wound was inspected 48 hours, 7 days and one month after the Cesarean section.
Results of our study demonstrated that Subcuticular group had less frequent serous discharge, hemoserous discharge, bloody discharge and stitch removal problems but more frequent SSI than interrupted group, but the difference was statistically non-significant.
As regards skin closure time it was significantly lower in subcuticular group. And the cosmotic outcome and patient satisfaction was significantly better in subcuticular group.
The use of subcuticular suture in skin closure in obese patients was not assosciated with significant increase in SSI compared to interrupted mattress suture.
Cesarean birth is one of the most common laparotomies done in the world today, thus any useful refinement in the operative technique, however minimal, is likely to yield substantial benefits. The surgical technique for cesarean birth has changed from time to time, from surgeon to surgeon and these changes were involved both of the uterine and the skin incisions (Cunningham et al., 2002)
Caesarean section is a common operation with no agreed standard on operative techniques and materials to use. The skin layer can be repaired by sub cuticular stitch immediately below the skin layer, an interrupted stitch or with skin staples. A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women (Alderdice et al., 2010).
Surgical site infection is a common complication of surgery. Infection has always been a feature of modern surgery and continues to be a significant problem for health care practitioners across the world. Surgical site infection is a common and major cause of postoperative morbidity. Its morbidities range from delayed healing to systemic sepsis.
Factors known to be associated with poor wound healing include obesity, diabetes mellitus, anemia, malnutrition, choice of suture material and surgical techniques (Gall, 1988).
Although several factors contribute to cesarean wound complications, the optimal method of skin closure to minimize these complications is unknown.
whereas two large-scale international trials are underway comparing different techniques of cesarean delivery, none is evaluating methods of skin closure.
The aim of this study is to determine the surgical site infection rate and patient satisfaction in obese patients undergoing cesarean section using subcuticular suture compared to interrupted mattress suture in skin closure.
There were 5 RCT comparing subcuticular suture with staples (Frishman et al., 1997), (Gaertner et al., 2008), (Rousseau et al., 2009), (Cromi et al., 2010), (Basha et al., 2010). Primary outcomes were rates of wound dehiscence (separation) and a composite wound complication rate. Secondary outcomes were patient satisfaction, operating time, and postoperative pain. A total of 877 women from 5 trials were included. Both wound separation (pooled odds ratio, 4.01; P_.0001) and composite wound complication (pooled odds ratio, 2.11; P _ .003) rates were higher with staples. The use of staples reduced operating time (weighted mean difference, –5.05 minutes; P _ .021).
This is a randomized controlled trial conducted in Ain-Shams University Maternity Hospital. It included 130 pregnant women who underwent elective Cesarean section.
The patients included were any female in childbearing period, planned for elective Cesarean section and Obese (BMI ≥ 30 Kg/m2).
Excluding patients who have concurrent overt infection (e.g. chorioamnionitis, pyelonephritis or chest infection), Women who have intraoperative events that may themselves predispose to perioperative infection (e.g. bowel injury, operative time more than 90 minutes, major blood loss) and Women who have hemoglobin less than 10g/dl, pre-eclampsia, rupture of membranes more than 12 hours, immunocompro-mised.
The participants were divided in two groups: group I include 67 women and had there skin closed with interrupted mattress suture, group II include 63 women and had there skin closed with subcuticular suture.
To our knowledge no other study evaluated the role of skin closure methods in the incidence of SSI in obese patients. In the current study all Cesarean section procedures were performed by surgeons who at least have a 2-year experience in practicing Cesarean sections. Antibiotic prophylaxis was given, as two intravenous doses of broad-spectrum penicillins [after clamping of the umbilical cord and 12 hours postoperatively]. Oral antibiotic of the same group was then started for 3-5 days. Any scar of previous cesarean section was removed. After closure of the fascial layer, subcutaneous tissue was closed if it was deeper than 2 cm. Subcutaneous drains were not left in any of the included women. Skin was closed by the closure method according to the allocated group i.e. interrupted mattress stitches using non-absorbable polypropylene 1 in group I and subcuticular stitches using non absorbable polypropylene 2-0 in group II. Wound was uncovered 24 hours postoperatively, and dressed, while uncovered, with alcohol 70% antiseptic solution for 7 days. The wound was inspected 48 hours, 7 days and one month after the Cesarean section.
Results of our study demonstrated that Subcuticular group had less frequent serous discharge, hemoserous discharge, bloody discharge and stitch removal problems but more frequent SSI than interrupted group, but the difference was statistically non-significant.
As regards skin closure time it was significantly lower in subcuticular group. And the cosmotic outcome and patient satisfaction was significantly better in subcuticular group.
The use of subcuticular suture in skin closure in obese patients was not assosciated with significant increase in SSI compared to interrupted mattress suture.