CC BY-NC-ND 4.0 · Am J Perinatol 2022; 39(09): 0951-0958
DOI: 10.1055/s-0040-1721112
Original Article

Antimicrobial Dressing versus Standard Dressing in Obese Women Undergoing Cesarean Delivery: A Randomized Controlled Trial

1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Ashley E. Salazar
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Lindsey Allen
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
George R. Saade
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
› Author Affiliations
Funding This trial was funded by Eloquest Healthcare, Inc., MI. The funder did not have any role in the conduct of the trial, analysis of the data, or drafting of this manuscript.

Abstract

Objective This study aimed to evaluate the effect of a novel antimicrobial dressing on patient satisfaction and health-related quality of life (HRQoL) following a cesarean delivery.

Study Design  This was an open-label, single-center, two-arm randomized controlled trial. This study was done at the tertiary center, maternal unit, Galveston, TX. Pregnant women with body mass indices ≥35 kg/m2 were screened for eligibility. Women were randomized to ReliaTect Post-Op Dressing (RELIATECT) or standard wound dressing (STANDARD). Primary outcome was patient satisfaction and HRQoL using validated questionnaires. Secondary outcomes were provider satisfaction, surgical site infection (SSI) rates, and wound complications.

Results In total, 160 women were randomized. Population characteristics were not significant among groups. RELIATECT dressing group had an overall higher score of satisfaction and HRQoL compared with STANDARD group. Women in the RELIATECT group reported less incision odor and incisional pain. Compared with the STANDARD group, most women in RELIATECT dressing group reported better daily activities, self-esteem, personal hygiene, body image, and sleep. Providers reported that the RELIATECT dressing allowed better assessment of the surgical incision site, allowed patients to shower early, and did observe less wound dressing leakage. No differences were found in other secondary end points.

Conclusion Postcesarean RELIATECT dressing for wound care in pregnant women with obesity had better patient and provider satisfaction as well as better HRQoL scores. Further, level 1 evidence is needed to assess its impact on SSI rates and wound complication, as this trial was not powered to accomplish this goal.

Key Points

  • This study was conducted to evaluate RELIATECT on patient satisfaction and HRQoL following a cesarean.

  • Post-cesarean RELIATECT dressing for wound care had better HRQoL and patient and provider satisfaction scores.

  • This is the first randomized controlled trial evaluating RELIATECT dressing in obese pregnant women undergoing cesarean section.

Clinical Trial Registration

ClinicalTrials.gov; date of registration: March 22, 2019; date of first enrollment: April 18, 2019; available at: https://clinicaltrials.gov/ct2/show/NCT03887299


Authors' Contributions

A.F.S., A.E.S., and G.R.S. conceived the study and editing the final manuscript. A.F.S. and G.R.S. were involved in data analysis, interpretation of data, drafting of manuscript, and critical review and editing the manuscript. A.F.S. and L.A. were involved in data abstraction/extraction. L.A. was involved in data abstraction. All authors approved the final version for submission.


Note

After review and determination by the University of Texas Medical Branch Galveston Hospital Institutional Review Board (Name: “Institutional Review Board,” 301 University Boulevard, Galveston, TX 77550-0158), our research project (IRB protocol # 18-0265) was found to meet the criteria for approval on March 8, 2019. Written informed consent was obtained from all participants prior to inclusion and randomization in the study. Participants were identified by number, not by name.




Publication History

Received: 09 September 2020

Accepted: 06 October 2020

Article published online:
02 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One 2016; 11 (02) e0148343
  • 2 Benson J. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2013; 121 (04) 878-879
  • 3 Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20 (11) 725-730
  • 4 NICE Guideline Updates Team. Surgical site infections: prevention and treatment. London, UK: National Institute for Health and Care Excellence; 2019
  • 5 Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol 1980; 55 (05) 178S-184S
  • 6 Walter CJ, Dumville JC, Sharp CA, Page T. Systematic review and meta-analysis of wound dressings in the prevention of surgical-site infections in surgical wounds healing by primary intention. Br J Surg 2012; 99 (09) 1185-1194
  • 7 Poston L, Caleyachetty R, Cnattingius S. et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 2016; 4 (12) 1025-1036
  • 8 Schwartz CE, Andresen EM, Nosek MA, Krahn GL. RRTC Expert Panel on Health Status Measurement. Response shift theory: important implications for measuring quality of life in people with disability. Arch Phys Med Rehabil 2007; 88 (04) 529-536
  • 9 Ostir GV, Markides KS, Black SA, Goodwin JS. Emotional well-being predicts subsequent functional independence and survival. J Am Geriatr Soc 2000; 48 (05) 473-478
  • 10 Pressman SD, Cohen S. Does positive affect influence health?. Psychol Bull 2005; 131 (06) 925-971
  • 11 Schulz KF, Altman DG, Moher D. CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Obstet Gynecol 2010; 115 (05) 1063-1070
  • 12 Manoharan V, Grant AL, Harris AC, Hazratwala K, Wilkinson MP, McEwen PJ. Closed incision negative pressure wound therapy vs conventional dry dressings after primary knee arthroplasty: a randomized controlled study. J Arthroplasty 2016; 31 (11) 2487-2494
  • 13 Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20 (05) 271-274
  • 14 Davey HM, Barratt AL, Butow PN, Deeks JJ. A one-item question with a Likert or visual analog scale adequately measured current anxiety. J Clin Epidemiol 2007; 60 (04) 356-360
  • 15 Fergusson D, Aaron SD, Guyatt G, Hébert P. Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. BMJ 2002; 325 (7365): 652-654
  • 16 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20 (04) 250-278 , quiz 279–280
  • 17 Black JD, de Haydu C, Fan L, Sheth SS. Surgical site infections in gynecology. Obstet Gynecol Surv 2014; 69 (08) 501-510
  • 18 Eaglstein WH, Davis SC, Mehle AL, Mertz PM. Optimal use of an occlusive dressing to enhance healing. Effect of delayed application and early removal on wound healing. Arch Dermatol 1988; 124 (03) 392-395
  • 19 Dumville JC, Gray TA, Walter CJ. et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2016; 12 (12) CD003091
  • 20 Borkar NB, Khubalkar MV. Are postoperative dressings necessary?. J Wound Care 2011; 20 (06) 301