scholarly journals Subcutaneous Antibiotic Irrigation to Prevent Wound Infection in Obese Patients Undergoing Cesarean Section

2021 ◽  
Vol 4 (3) ◽  
pp. 01-05
Author(s):  
Aliaa M. Maaty ◽  
Amr H. Yehia ◽  
Mohamed M. Abdelaleem ◽  
Mohammed A. Abd El-Fattah
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Subcutaneous Tissue ◽  
Elective Cesarean Section ◽  
Wound Complications ◽  
Control Group ◽  
Obese Patients ◽  
Obese Women ◽  
Wound Irrigation ◽  
Maternity Hospitals

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution ( 1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them . postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, In obese women undergoing elective CS , wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.

scholarly journals Effect of Amh in Patients with Polycystic Ovarian Syndrome on Pregnancy Rate in Icsi Cycle

2021 ◽  
Vol 4 (4) ◽  
pp. 01-05
Author(s):  
Ahmed Mohamed Abd El-Hay
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Subcutaneous Tissue ◽  
Elective Cesarean Section ◽  
Wound Complications ◽  
Control Group ◽  
Obese Patients ◽  
Obese Women ◽  
Wound Irrigation ◽  
Maternity Hospitals

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution (1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them. Postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, in obese women undergoing elective CS, wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.

scholarly journals Prevention of large and giant postoperative ventral hernia prosthetic hernioplasty postoperative complications

2013 ◽  
Vol 94 (3) ◽  
pp. 417-420
Author(s):  
O T Alishev ◽  
R S Shaimardanov ◽  
Y R Makhmutova
Keyword(s):  
Ventral Hernia ◽  
Comparison Group ◽  
Subcutaneous Tissue ◽  
Main Group ◽  
Wound Complications ◽  
Control Group ◽  
Abdominal Pressure ◽  
Narcotic Analgesics ◽  
Wound Irrigation ◽  
Average Pain

Aim. To evaluate the effectiveness of regional prolonged irrigation with ropivacaine ozonated solution at large and giant postoperative ventral hernia prosthetic hernioplasty. Methods. 77 patients who underwent a planned surgery for large and giant postoperative ventral hernia from 2010 to 2012 were examined. All patients were distributed to two groups. The main group included 26 patients in whom a polyvinyl chloride catheter was installed in periprosthetic tissue for the wound irrigation using anesthetic (ropivacaine) ozonated solution for regional prolonged anesthesia and wound complications prevention as well as for preoperative preparation and intra-abdominal pressure monitoring for abdominal compression syndrome prevention using the technique developed by authors. The comparison group consisted of 51 patients in whom prevention of wound complications was carried out conventionally, and who received narcotic analgesics. Ultrasonography of postoperative wound area was used for local inflammation intensity assessment. Pain was assessed using numeric visual analogue scale in both groups. Results. 4 (15.4%) patients of the main group developed subcutaneous tissue seroma at the 5-6th day. In comparison group wound complications were registered in 15 (29.4%) patients, including 11 cases of seromas, 2 cases of suppurative inflammation, 1 case of ischemic necrosis of the wound edges, and also an isolated case of limphorrhea which occurred on the first day. The observations showed that the average pain level among patients of the main group was 3.8±0.4 points, compared to the control group - 5.3±0.4 points. Conclusion. Periprosthetic irrigation with ropivacaine ozonated solution provides adequate anesthesia, reduces the number of wound complications and promotes early rehabilitation.

scholarly journals Incision length: an emerging risk factors for surgical‐site infection following cesarean section

2017 ◽  
Vol 6 (5) ◽  
pp. 1829 ◽  
Author(s):  
Tripti Nagaria ◽  
Avinashi Kujur ◽  
Neha Thakur
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Subcutaneous Tissue ◽  
Mode Of Delivery ◽  
Wound Complications ◽  
Late Nineteenth Century ◽  
Site Infection ◽  
Operating Characteristics ◽  
Incision Length

Background: Since late nineteenth century, the caesarean section first done there is a tremendous improvement in the surgical and anaesthetic skills. It has emerged as a safe mode of delivery but now, in the present era there is a continuous rising trend of caserean section. Objective of present study is to evaluate the effect of some specific gestational factors and other known variables associated with poor wound healing in women who delivered by cesarean section.Methods: A total of 1215 women delivered by cesarean section at Pt. JNM Medical college, Raipur, Chhattisgarh, India from May 2014 to April 2015 were included in this study. The BMI was measured at gestational age when she got operated, grade of surgeons was noted. Subcutaneous tissue depth was intra-operatively measured from the fascia to the skin surface, while the incision length was measured after skin closure.Results: Out of 1215 women operated 251 cases developed SSI with incidence of 20.5%. Incision length (OR 2.40, 95% CI 2.11-2.73; p<0.0001), Body mass index (BMI) at term (OR 2.9, 95% CI 1.82-4.44; <0.0001), previous caesarean section scar (OR 0.72, 95% CI 0.54-0.96; p=0.02), Grade of surgeon (OR 5.5, 95% CI 3.3-9.3; p<0.0001), subcutaneous tissue thickness (OR 1.88, 95% CI 1.60-2.23, p<0.0001) were found to be correlated with wound complications. The receiver operating characteristics curve analysis suggested a cut-off of 28.7 for the BMI at term with AUC 0.8 (0.79-0.84, p<0.0001) and 147 mm for the wound length with an AUC 0.8 (95% CI 0.78-0.82; p <0.0001). The multivariate logistic regression model, applied to these variables showed an independent correlation of incision length with SSI   incision length >14.7; OR 2.40, 95% CI 2.11-2.73, p<0.0001.Conclusions: Incision length by itself was found to be an independent risk factor for development of surgical site infection.

scholarly journals LINEA ALBA COLLAGEN ASSESSMENT IN MORBIDLY OBESE PATIENTS

2016 ◽  
Vol 29 (suppl 1) ◽  
pp. 8-11
Author(s):  
João Vicente Machado GROSSI ◽  
Felipe Fernandes NICOLA ◽  
Ivan Alberto ZEPEDA ◽  
Martina BECKER ◽  
Eduardo Neubarth TRINDADE ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Healing Process ◽  
Age Groups ◽  
Immunohistochemical Analysis ◽  
Control Group ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Age Group ◽  
Tissue Thickness ◽  
Linea Alba

ABSTRACT Background: The evaluation of collagen in the abdominal wall has been increasingly studied because of the relevance on collagen in the healing process after laparotomy. Aim: To evaluate the amount of collagen in the linea alba of patients undergoing laparotomic bariatric surgery and comparing with non-obese cadavers. Methods: Were evaluated 88 samples of aponeurosis from abdominal linea alba of 44 obese patients (obesity group) and 44 non-obese cadavers (control group). The samples were collected in 2013 and 2104, and were sorted according to age (18-30, 31-45 and 46-60), gender, BMI, waist and cervical circumference, and subcutaneous tissue thickness. Material for biopsy was collected from the supraumbilical region of the linea alba for immunohistochemical analysis differentiating collagen type 1 and type 3 and the 1/3 ratio. Image-Pro Plus pixel counting software was used to measure the amount of collagen. Results: The obesity group evidenced mean age 44.11±9.90 years; 18-30 age group had three (6.8%) obese individuals; 31-45 had 22 (50%) and 46-60 had 19 (43.1%). Females were present in 81.8% (n=36); BMI (kg/m²) was 48.81±6.5; waist circumference (cm) was 136.761±13.55; subcutaneous tissue thickness (cm) 4.873±0.916. Considering age groups, gender and BMI, there were statistical differences in all tests when compared with the cadavers. Conclusion: The amount of collagen in the linea alba above the umbilical region in the morbidly obese patients was smaller than in the non-obese cadavers in the same age group.

Cesarean section incisional infiltration with lidocaine and Epinephrine versus Lidocaine alone in reducing postoperative pain. A randomized controlled double-blinded clinical trial

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem F El-Shahawy ◽  
Sherif F El-Mekkawi ◽  
. Haitham F Mohmmed ◽  
Hend M Afifi
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Breast Feeding ◽  
Local Anesthetic ◽  
Elective Caesarean Section ◽  
Control Group ◽  
Cesarean Section Delivery ◽  
Anesthetic Effect

Abstract Background Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation Aim of the Work to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia. Patients and Methods A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only. Results women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia. Conclusion Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000

scholarly journals A Implementation of Antibiotic Prophylaxis Program for Cesarean Section at Thai Nguyen National Hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nguyen Thi Thu Thuy ◽  
Nguyem Thanh Hai ◽  
Nguyem Xuan Bach ◽  
Hoang Thi Thu Huong ◽  
Nguyem Chi Cuong ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Viet Nam ◽  
National Hospital ◽  
Ministry Of Health

This study aims to evaluate the effectiveness of the use of antibiotic prophylaxis in cesarean section at Thai Nguyen National Hospital as a first pilot activity of a surgical prophylaxis program. In the study, a randomized controlled trial was designed with two groups: intervention group and control group. Patients characteristics and effectiveness of prophylactic antibiotics for caesarean section were compared. The study results show that the patients’ ages ranged from 18 to 44 years; most of the patients had ASA score of 1; and mean hospital length of stay was statistically significant between the two groups (p<0.05). Regarding the indication of caesarean section, the reason of genital tract abnormalities accounted for the highest proportion. The percentage of the patients switching from prophylactic antibiotic regimens to therapeutic antibiotics in the intervention group was 2%. There was no patient with superficial and/or deep incisional surgical site infections in both groups. The difference in mean number of injections in the two groups was statistically significant (p<0.05). The average cost of antibiotics for each patient in the intervention group and control group were 267.720 VND and 543.871 VND, respectively. The study concludes that the effectiveness of antibiotics prophylaxis for caesarean section: 99% of the patients were without wound infection; hospital length of stay in the intervention group was shorter than the control group; and using prophylactic antibiotics was not only more economical but could also reduce the workload of medical staff, costs of antibiotics and medical supplies. Keywords  Antibiotics prophylaxis, caesarean section, Thai Nguyen National Hospital. References [1] Viet Nam Ministry of Health, National guideline on prevention of surgical site infection, issued with Decision No. 3671/QD-BYT, September 27, 2012 of Viet Nam Ministry of Health, Ha Noi, 2012 (in Vietnamese).[2] Viet Nam Ministry of Health, National guideline on antibiotics use, issued with Decision No.708/QD-BYT, March 2, 2015 of Viet Nam Ministry of Health, Ha Noi, 2015 (in Vietnamese).[3] D.W. Bratzler, K.M. Olsen, et al., Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, American Journal of Health-System Pharmacy 70 (2013) 195 – 283. https://doi.org/10.2146/ajhp120568.[4] R.F. Lamont, J.D. Sobel, et al., Current debate on the use of antibiotic prophylaxis for caesarean section, BJOG: An International Journal of Obstetrics & Gynaecology 118 (2011) 193-201. https://doi.org/10.1111/j.14710528.2010.02729.x.[5] T.V. Khai, Infection rate of surgical incisions and associated factors on women after cesarean section at Dong Nai General Hospital, Scientific Research Project of Dong Nai Hospital, 2015 (in Vietnamese).[6] N.H. Tuan, Study on the use of cefazolin to prevent infection after cesarean section or uterine fibroids surgery at the Institute of maternal and neonatal protection, Master’s thesis, Hanoi University of Pharmacy, 2002 (in Vietnamese).[7] F.M. Smaill, R.M. Grivell, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, Cochrane Database Syst Rev 10 (2014) CD007482. https://doi.org/10.1002/14651858.cd007482.pub3.    

scholarly journals Anaesthetic Management of a Morbidly Obese Parturient for Elective Caesarean Section

2016 ◽  
Vol 10 (2) ◽  
pp. 64-66
Author(s):  
R Pradhan ◽  
S Shrestha ◽  
T Gurung ◽  
AB Shrestha ◽  
KR Sharma
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Epidural Anaesthesia ◽  
Gestational Hypertension ◽  
Elective Caesarean Section ◽  
Anaesthetic Management ◽  
Elective Cesarean Section ◽  
Morbidly Obese ◽  
Elective Cesarean ◽  
Spinal Epidural

Anaesthesia for an obese parturient poses a challenge to anaesthesiologists. Here we report a case of 27 years obese primigravidae at 40 weeks of gestation with gestational hypertension who underwent elective cesarean section under combined spinal epidural anaesthesia. Her intraoperative and postoperative periods were uneventful. 

scholarly journals Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

2018 ◽  
Vol 1 (2) ◽  
pp. 70-74
Author(s):  
Rohini Sigdel ◽  
Maya Lama ◽  
Sanish Gurung ◽  
Bishal Gurung ◽  
Anil Prasad Neupane ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Operating Table ◽  
Hemodynamic Effects ◽  
Elective Cesarean ◽  
Spinal Hypotension ◽  
The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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