Cesarean Wound Closure in Women With BMI 40 or Greater

Pediatrix

Status: Completed

Conditions: C.Delivery; Penetration, Pregnant Uterus, by Instrument; Obesity

Treatments: Procedure: Randomizing to Suture or Staple closure of Cesarean section

Study type: Interventional

Funder types: Other

Identifiers

NCT02549131

Cesarean Closure

Details and patient eligibility

About

The purpose of this randomized controlled prospective trial is to guide physicians on the most effective evidenced based skin closure during a cesarean section for the obese gravida, defined as a BMI of 40 or greater. The study will compare two closure methods: subcuticular sutures and surgical staples.

Full description

The study will screen and attempt to enroll pregnant women admitted to labor and delivery who have a BMI of 40 or greater. The participants will be randomized to receiving skin closure with subcuticular sutures or surgical staples if they undergo cesarean section. Either technique is currently standard of care. Participants who end up undergoing cesarean section will be included in the final data analysis. The participants will be followed for wound complication in the first 6 weeks post operatively. Wound complication will be defined as wound disruption or infection within 6 weeks post operatively.

Design and Project Type This study is a randomized controlled trial. At the study facility, in 2012 and 2013, over 300 cesarean sections were performed each year in women with BMI of 40 or greater. Based on this, the investigators expect the duration of the study to be 2 years. Randomization and data collection will be completed on 420 women.

Description of Intervention Two interventions will be used in this project: subcuticular suture and surgical staples. The subcuticular suture will be the size and type of suture chosen by the surgeon at the time of cesarean. The surgical staples will be the standard staples used on the labor and delivery unit.

Enrollment: 232 patients

Sex: Female

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Pregnant woman
• Time to approach and consent the patient prior to undergoing cesarean delivery
• Able to give informed consent, include age 18 or greater and ability to read and understand English
• BMI of 40 or greater on most recent hospital documentation
• Willingness to participate in the study and ability to read, understand and sign the informed consent document

Exclusion criteria

• Inability to give informed consent, including inability to read and understand English and age under 18 years
• Evidence of current skin infection or breakdown at or near the site of surgical incision
• Any immune compromised status, including AIDS
• Negative pressure wound therapy applied at time of surgery

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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232 participants in 2 patient groups

Suture

Active Comparator group

Description:

Randomizing to Suture closure of Cesarean Section wound. In woman meeting inclusion criteria and not meeting exclusion criteria.

Treatment:

Procedure: Randomizing to Suture or Staple closure of Cesarean section

Staples

Active Comparator group

Description:

Women in this Arm will be assigned to Standard Surgical Staples closure of Cesarean section. Women will have met inclusion criteria and not meet exclusion criteria and willing to consent to study. Intervention is the randomization to either Arm. Both are standard of care at this facility.

Treatment:

Procedure: Randomizing to Suture or Staple closure of Cesarean section