Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections

Abstract

Purpose: Surgical site infections (SSIs) after cesarean section cause maternal morbidity and economic and emotional burdens on society. Our aim is to measure procalcitonin (PCT) levels in patients who developed incisional SSIs after cesarean section while also comparing PCT concentrations between patients who underwent a secondary suture and who did not require a secondary suture.

Methods: Ninety-four patients who developed incisional SSI after cesarean section were enrolled in our study. At the time of admission, serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured. The study population was grouped into two, based on the need of a secondary suture and the patients baseline blood tests were compared.

Results: The mean serum CRP level was not significant among the groups; however, the median serum PCT level was significantly higher in patients who required a secondary suture (0.21 vs. 0.05?ng/ml, p?≤?.0001). Serum PCT levels were positively correlated with the length of hospital stay (r?=?0.72, p?=?.0001). Area under the curve (AUC) for PCT in predicting the need of a secondary suture was 0.85 (95% CI: 0.772–0.922) and the cutoff point was 0.142?ng/ml with a sensitivity of 75% and specificity of 97.8% (p?=?.0001).

Conclusion: Serum PCT is a promising marker for both diagnosing and predicting the severity of SSIs after cesarean sections.

Trial registration: ClinicalTrials.gov identifier: NCT03223233.     

Treatment of abscesses in the vulva. Conventional open treatment versus primary suture under antibiotic cover

Seventy patients were treated for a subcutaneous abscess in the vulva. In 35 consecutive patients the abscess was treated conventionally with deroofing of the abscess and wet dressings. In the other 35 consecutive patients the abscess was treated by incision, curettage and primary suture under antibiotic cover with a single dose of clindamycin. In the conventionally treated group the median stay in hospital was 7 days and the median healing time 18 days. In the group treated by primary suture the median stay in hospital was 2 days and the median healing time 7 days (P less than 0.0001). Recurrence of abscess was observed in one patient in each group. No other complications were observed in either group. It is concluded that vulvar abscesses may be treated safely and advantageously by primary suture under antibiotic cover.     

Randomized trial of amniotomy in labour versus the intention to leave membranes intact until the second stage.

OBJECTIVE: To compare by randomized prospective clinical trial the outcome of labours which are managed with the intention to leave the membranes intact, compared with the practice of elective artificial rupture of the membranes (ARM) in early established labour. DESIGN: Prospective randomized controlled trial of low risk women admitted in spontaneous labour, with intact membranes. SETTING: The labour ward of St. James's University Hospital, Leeds, UK. SUBJECTS: 362 women in spontaneous labour with intact membranes and no evidence of fetal distress, between 37 and 42 weeks gestation. During the course of the trial it was found that some randomization cards could not be accounted for and a system of daily checks was instituted. The results were analysed for all recorded women (n = 362) and after institution of the more rigorous system (n = 120). MAIN OUTCOMES MEASURED: The duration of each phase of labour, epidural rate, prevalence of an abnormal cardiotocograph (CTG) (assessed blind), method of delivery and neonatal outcome. RESULTS: 178 of the 183 women (97%) in the ARM group had their membranes ruptured in early labour, and 83 (46%) of the 179 women allocated to non-intervention had ARM performed at some stage. A significant decrease in the duration of labour (mean 8.3, SD 4.1 h vs mean 9.7, SD 4.8 h, n = 156; P = 0.05) was found amongst primigravidae allocated to ARM when compared with non intervention. The duration of the second stage of labour was unaffected. In the ARM group the epidural rate was higher and labour was more often complicated by CTG abnormalities. There were no differences in the method of delivery, fetal condition at birth (cord blood lactate, Apgar score) or postpartum pyrexia between the ARM and non-intervention groups. The same trends were observed when analysis was confined to women entered into the trial after the system of rigour was instituted. CONCLUSION: Routine ARM results in labour that is slightly shorter than if the membranes are allowed to rupture spontaneously but more epidurals are used suggesting that labour is more painful. There are fewer fetal heart rate abnormalities if the membranes are left intact but amniotomy has no effect on fetal condition at birth.     

Linear ampullary salpingotomy heals better by secondary versus primary closure

The conservative surgical management of ampullary ectopic pregnancy is often performed by linear ampullary salpingotomy. The Author has studied in rabbits healing mechanisms involved following this operation with reference to either primary or secondary closure of the tubal wound. This study seems to demonstrate that the closure of the unsutured ampullary salpingotomy wound occurs with good morphological and functional result in the pregnant rabbit.     

Effect of suture materials on healing wounds of the stomach and colon.

Wound healing in the stomach and colon of mongrel dogs was studied using physical, histologic and chemical techniques to evaluate effects of various suture materials on the healing pattern and to compare visceral wounds with skin wounds. The general pattern of healing for stomach and colon wounds is the same in rats, rabbits and dogs. However, the extent of healing, the percentage of strength of normal tissue attained by the wound, is less in the dog than in the rat or rabbit. Prolene and plain and chromic catgut produce the least and silk produces the greatest cellular reaction in the stomach and colon. We believe the effect of absorbable sutures on strength of stomach and colon wounds, while statistically significant, is not of any great clinical significance except perhaps in severely debilitated patients. A trial of Prolene sutures for anastomotic closure would seem indicated. The healing of stomach and colon wounds differs from the pattern observed for skin wounds. Breaking strength increases rapidly for 14 to 21 days postwounding and then does not change significantly. The wounds are metabolically more active than skin wounds since the rate of collagen synthesis is markedly elevated even after 120 days and the rate of noncollagenous protein synthesis is twice as great in the wound as it is in normal tissue. Colon and stomach wounds closed with absorbable sutures are weaker at 14 through 28 days than similar wounds closed with nonabsorbable sutures. Yet, when strength of wound is expressed as a percentage of strength of unwounded tissue, there is no difference between wounds blosed with absorbable or nonabsorbable sutures. Thus, it would appear that there is a general diminution of the strength of normal stomach and colon wall up to 6 centimeters from wounds which have been closed with absorbable sutures.     

Early second trimester prenatal diagnosis of Neu-Laxova syndrome

Neu-Laxova is a rare, uniformly lethal, autosomal recessive condition with characteristic limb posturing, facial dysmorphic features, and central nervous system abnormalities. Forty-two cases of Neu-Laxova syndrome have been reported, with only four of these diagnosed prenatally. Three of the four cases were diagnosed at or after 32 weeks' gestation. The fourth case was diagnosed at 22 weeks' gestation in a patient who was followed with serial ultrasound studies due to having a prior affected child. At 19 weeks' gestation, we present the earliest reported prenatal diagnosis of Neu-Laxova syndrome in a primigravida with a non-informative family history.     

Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy

OBJECTIVE: To compare blood loss and procedure time of vaginal hysterectomy using an electrosurgical bipolar vessel sealer versus using sutures. METHODS: Sixty patients scheduled for vaginal hysterectomy in a single surgical practice were randomized to either electrosurgical bipolar vessel sealer or sutures as the hemostasis technique. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the anesthesia service. Statistical methodology included the Student t and Wilcoxon rank-sum tests, and all comparisons were two tailed, with P <.05 considered significant. RESULTS: Use of an electrosurgical bipolar vessel sealer resulted in shorter procedure times: The mean procedure time in the electrosurgical bipolar vessel sealer arm was 39.1 minutes (range 22-93) versus 53.6 minutes (range 37-160) for the suture arm (P =.003). Mean estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer: 68.9 mL (range 20-200) versus 126.7 mL (range 25-600) for the suture arm (P =.005). Complication rate and length of stay did not differ by hemostasis technique. Seventy-eight percent of all cases were outpatient. CONCLUSION: Electrosurgical bipolar vessel sealer is an effective alternative to sutures in vaginal hysterectomy, resulting in significantly reduced operative time and blood loss.     

Randomised controlled trial of LigaSure versus conventional suture ligature for abdominal hysterectomy

OBJECTIVE: To compare the use of LigaSure with conventional suture ligature in abdominal hysterectomy. DESIGN: Pilot randomised controlled unblinded trial with block randomisation according to three operating surgeons. SETTING: One Norwegian teaching hospital, Department of Gynaecology and Obstetrics. SAMPLE: Thirty women who underwent total or subtotal abdominal hysterectomy. METHODS: Data, with regard to operation time expenditure and the occurrence of peri- and post-operative complications, were collected and compared between the two techniques. MAIN OUTCOME MEASURES: Operation time, peri- and post-operative complications. RESULTS: Mean operation duration was 61.7 minutes with LigaSure and 54.5 minutes with conventional suture ligature. The corresponding operative blood loss was 303 and 298 mL, respectively. Occurrence of complications was few and not significantly different between the two techniques. Mean hospital stay was longer following LigaSure operations (10 vs 6 days), probably due to a certain age imbalance between the study groups. CONCLUSIONS: Within the limitation of this pilot study, we did not uncover a time sparing effect from the use of LigaSure or any difference in the occurrence of blood loss and complications.     

Factors associated with second childbirth intention: focusing on value of children in Korean married women

Background: The value placed on having children represents one important motivation for childbearing. Our aim was to examine the relationship between the value placed on children by women and their preference for a second child. Methods: Data on women with a child (299 employed women and 424 stay-at-home mothers aged 20–44 years) were obtained from the Korean National Fertility and Family Survey. Multivariate logistic regression analyses were conducted to assess the relationship between the perceived value of children and the intention to have a second child. Results: The psychological benefits of having children, such as emotional comfort in the elderly years, was associated with higher second-childbirth intention in stay-at-home mothers (p < .05). In addition, the awareness of South Korean government’s childrearing support services were associated with higher second-childbirth intention among stay-at-home mothers. Conclusions: Understanding and responding to the individual responses of stay-at-home mothers to motherhood and of their perceptions of the value they place on having children requires the promotion and provision of perinatal mental health services. In addition, expansion of flexible working patterns is needed among employed women.     

Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas

STUDY OBJECTIVE: To compare the functional ovarian damage associated with the use of bipolar coagulation versus ovarian suture after laparoscopic excision of ovarian endometriomas in patients with a solitary ovary. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary care center. PATIENTS: Forty-seven consecutive women with a single ovary and regular menses who underwent laparoscopic stripping of one or more ovarian endometriomas between June 1996 and June 2001. Intervention. Twenty-one patients had bipolar electrocoagulation (group A), while 26 had suturing of the ovary (group B). Plasma follicle-stimulating hormone (FSH) and estradiol levels were determined before surgery and re-evaluated at 3-, 6-, and 12-month follow-up. MEASUREMENTS AND MAIN RESULTS: At 12-month follow-up, six patients (29%) in group A had oligo-amenorrhea versus three patients (12%) in group B (p = .14). Follicle-stimulating hormone levels between 10 and 20 mlU/mL were found in five patients (24%) in group A and in three patients (12%) in group B, whereas FSH levels above 20 mlU/mL were found in three patients (14%) in group A and in no patient in group B. Eight patients (38%) in group A had FSH levels greater than 10 mlU/mL versus three patients (12%) in group B (p = .042). Overall, repeated analysis of variance showed a marginally significant difference (p = .06) in FSH values between the two groups. CONCLUSION: Our results suggest that bipolar electrocoagulation of the ovarian parenchyma after laparoscopic stripping of an endometriotic ovarian cyst adversely affects ovarian function.