Can Evidence Based Interventions Reduce C-section Complications?
BACKGROUND AND PURPOSE:
Temming et. Al. (AJOG, 2017) sought to estimate the impact of evidence based measures including
Appropriate timing of prophylactic antibiotics within 60 minutes of cesarean delivery and before skin incision
2 g of cefazolin preoperatively for maternal weight <120 kg and 3 g for maternal weight ≥120 kg
Penicillin or cephalosporin allergy: 2 mg/kg gentamicin and 900 mg clindamycin
Chlorhexidine-alcohol for skin antisepsis with 3 minutes of drying time before incision
Closure of subcutaneous layer if ≥ 2 cm of depth
Subcuticular skin closure with suture
Secondary analysis of data from a randomized controlled trial (RCT) of 1082 chlorhexidine-alcohol vs iodine-alcohol for skin antisepsis at cesarean delivery between 2011-2015
Subjects were characterized as:
Received 4 evidence-based measures (listed above)
Did not receive the measures
Primary Outcome was a composite of wound complications within 30 days of delivery
surgical site infection
Individual components of the composite outcome
When comparing all the evidence-based measures compared with those who did not
The risk of any wound complications was significantly lower (20.3% vs 28.1%; adjusted relative risk 0.75 (95% CI 0.58-0.95)
The impact appeared to be driven by surgical site infection reduction (3.7% vs 9.3%; adjusted relative risk 0.43 (95% CI 0.24-0.76)
Of patients who received evidence-based measures, unscheduled cesarean delivery was the only risk factor for wound complications
Other risk factors, which include obesity, smoking, diabetes mellitus, chorioamnionitis, surgical experience, and skin incision type, were not significantly different between patients who received all measures and those that did not
Implementation of evidence-based measures significantly reduces wound complications
However, the residual risk remains high, suggesting the need for additional interventions, especially to reduce unscheduled cesarean deliveries
Please sign up or log in to your ObGFirst to access this Premium Content
Media - Internet
Computer System Requirements
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan