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.
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.
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 .
Although several factors contribute to cesarean wound complications, the
ptimal 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 diabetic 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.
Summary
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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 140 pregnant women who underwent elective
Cesarean section.
The patients ’included were any female in childbearing period, planned
for elective Cesarean section and diabetc (RBS > 140 mg/dl).
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, preeclampsia, rupture of
membranes more than 12 hours, immunocompro-mised.
The participants were divided in two groups: group I include 71
women and had there skin closed with interrupted mattress suture, group II
include 69 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 diabetic patients. In the current study all
women performed at least 1CS. 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 em. 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. in!errupted 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
Summary
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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 diabetic patients was not
assosciated with significant increase in SS (compared to interrupted mattress
suture.