Effect of Using Silver Nylon Dressings on Postoperative Pain after Cesarean Delivery.

OBJECTIVE: Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery. STUDY DESIGN: A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon-Mann-Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant. RESULTS: Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51-30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03-30.31) but not gauze dressing was associated with patient-reported postoperative pain. CONCLUSION: Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain. KEY POINTS: · Silver dressings showed no decrease in pain medications.. · Wound infection is associated with pain postoperatively.. · Silver dressings did not reduce postoperative pain..

Effect of using silver nylon dressings to prevent superficial surgical site infection after cesarean delivery: a randomized clinical trial.

BACKGROUND: Surgical site infections are associated with significant healthcare cost and burden. Silver-impregnated dressings have been associated with a decrease in surgical site infections in select populations, but it is unknown whether the benefit can be observed after cesarean deliveries. OBJECTIVE: We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. MATERIALS AND METHODS: A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted. Women were recruited for participation from September 2013 to June 2016. Women with vertical skin incisions were excluded. Enrolled participants were randomized to silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient office at 1 week and 6 weeks after delivery. The primary outcome was superficial surgical site infection as defined by Centers for Disease Control criteria at any time within the first 6 weeks after cesarean delivery. A sample size of 330 per group (n = 660) was planned to compare the 2 arms. Data were analyzed using the χ2, Fisher exact test, Student t test, Mann-Whitney U test, and logistic regression where appropriate, and a value of P < .05 was considered significant. RESULTS: Among the 657 participants, overall, the primary outcome was similar between the 2 groups (4.6% in the silver nylon group vs 4.2% in the gauze group, P = .96). Women allocated to silver nylon, when compared to those who were allocated to gauze, had similar rates of superficial surgical site infection within 1 week (1.2% vs 0.9%) and within 6 weeks ( 4.6% vs 4.2%) after delivery (P >.99). The 2 groups were similar in age (30.9 ± 5.6 vs 31.0 ± 5.5 years, P = .95), body mass index (36.2 ± 8.7 vs 35.3 ± 8.2 kg/m2, P = .19), pregestational diabetes (6.2% vs 3.4%, P = .14), gestational diabetes (7.9% vs 7.3%, P = .88), cesarean delivery after labor (31.9% vs 31.1%, P = .86), presence of chorioamnionitis (5.2% vs 2.1% P = .06), and operative time (56.4 ± 20.6 vs 55.9 ± 17 minutes, P = .69). After adjusting for clinical and sociodemographic confounding variables, current smoking (adjusted odds ratio, 4.9; 95% confidence interval, 1.8-13.4) body mass index ≥40 kg/m2 (adjusted odds ratio, 3.08; 95% confidence interval, 1.3-6.8), and surgery length (minutes) (adjusted odds ratio, 1.02; 95% confidence interval, 1.002-1.04), but not use of gauze dressing, were associated with superficial surgical site infections. CONCLUSION: Among women undergoing cesarean delivery, silver nylon dressing was not more effective than gauze in reducing the risk of superficial surgical site infections.

Purtscher-like Retinopathy After Placental Abruption.

BACKGROUND: Pregnant women are susceptible to visual disturbances, particularly with hypertension. Vision generally recovers postpartum within hours to days. A rare condition known as Purtscher-like retinopathy presents abruptly postpartum with visual field defects and blindness. Recovery of vision is unpredictable, occurring over several weeks and months. CASE: A 38-year-old woman presented at 34 weeks' gestation with contractions and heavy bleeding. Placental abruption was confirmed after a repeat cesarean was performed. Hours after delivery, she complained of central vision loss despite normal blood pressure and preeclamptic laboratory results. The diagnosis of Purtscher-like retinopathy was made, presumably from multiple infarcts to the retina caused by the placental abruption. CONCLUSION: Recovery from Purtscher-like retinopathy may result in permanent visual impairment.

Three decade old cold case murder solved with evidence from a sexual assault kit.

Sexual assault occurs at alarming rates in America. The true incidence remains unknown as many victims fail to both report for immediate medical care and notify law enforcement of the crime committed. For those who do seek medical assistance, a Sexual Assault Kit is available in Emergency Departments with established protocols for the forwarding of collected specimens to law enforcement. A crime lab analyzes the evidence to identify the offender's DNA. A DNA profile is then created and archived into a database. This case involved a woman who not only endured a sexual assault, but also sustained multiple gun shot wounds, and witnessed the murder of her friend nearly three decades ago. At that time, she was treated for her injuries and evidence was collected and secured into a Sexual Assault Kit. A DNA profile was then created from a predetermined crime lab. In 2011, a Cold Case Investigator, who was reviewing all archived DNA profiles of currently incarcerated individuals in the city where the initial crime was committed, was able to match a current prisoner's DNA to that of the DNA profile created from specimens collected during the sexual assault exam nearly thirty years ago. The perpetrator subsequently was charged with murder by the criminal justice system and received a thirty year sentence without opportunity for parole.

A retrospective study evaluating silver-impregnated dressings on cesarean wound healing.

OBJECTIVE: This retrospective study was designed to assess the effectiveness of silver-impregnated dressings in reducing postoperative wound care visits. DESIGN: A retrospective chart review of 72 patients was conducted to compare the effectiveness of silver-impregnated dressings with traditional wound dressings in reducing additional postoperative visits associated with surgical site infections (SSIs) in patients undergoing cesarean delivery: Prior to October 1, 2009, incisions of 36 women were covered with gauze pads. Subsequent to that date, Silverlon dressings (Cura Surgical, Geneva, Illinois) were applied to the wounds of the remaining 36 women. MAIN RESULTS: Two patients whose incisions were covered with a gauze pad and 2 patients who received the silver-impregnated dressings developed an SSI requiring additional wound care visits. Silver-impregnated dressings did not significantly reduce the rate of wound care-related postoperative visits, but the experimental group had a higher rate of comorbidities. CONCLUSIONS: Although there was no observed difference in the number of women requiring additional wound care visits, the significantly greater number of comorbidities noted in the silver-impregnated dressing group should have theoretically placed them at increased risk for SSIs and additional postoperative wound care visits, suggesting that silver-impregnated dressings may have more of a protective effect than is appreciated in this study. A randomized prospective study is planned to further assess its usefulness in decreasing the incidence of wound infections along with its potential benefits regarding wound appearance.