Reduction of adverse outcomes from cesarean section by surgical-site infection prevention care bundles in maternity.

OBJECTIVE: To reduce average surgical-site infection (SSI) rates to less than 7.5%, as well as other complications by incrementally implementing an SSI prevention care bundle in maternity: (1) ChloraPrep; (2) PICO dressings, performing elective cesarean sections in a main theater rather than a labor ward and warming blankets; (3) vaginal cleansing; and (4) Hibiscrub. METHODS: In this prospective cohort study, the association between categorical variables was assessed by χ2 tests, temporal trends in the monthly percentage change of SSI were measured using the Joinpoint Regression Program v4.7.0.0. RESULTS: In all, 1682 women (mean age 33.1 ± 5.2 years) underwent either elective (53.9%) or emergency (46.1%) cesarean section. After a small initial increase (10.0%-11.8%), SSI progressively declined to 4.4% (χ2  = 22.1, P < 0.001), as did sepsis, reoperation or readmission for SSI: from 12.5% to 0.5% (χ2  = 90.1, P < 0.001). The rates of SSI fell progressively with the cumulative introduction care bundle components. The average monthly percentage change was -14.0% (95% confidence interval -21.8% to -5.4%, P = 0.004), and the average SSI rate was kept below 7.5% for the last 12 months of the study. CONCLUSION: The maternal SSI prevention care bundle is simple and inexpensive; it effectively reduces SSI after a cesarean section and should be offered routinely to women undergoing cesarean section.

Evaluation of independent risk factors associated with surgical site infections from caesarean section.

BACKGROUND: The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section). METHODS: Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK). RESULTS: At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes. CONCLUSIONS: High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.

Relationship between neonatal gastroschisis and maternal body mass index in a United Kingdom population.

OBJECTIVE: It has been reported that gastroschisis is associated with low maternal body mass index (BMI). We tested this hypothesis in the UK. STUDY DESIGN: We studied cases of gastroschisis ascertained from the regional fetal congenital anomaly register. We compared each affected mother with two controls from the birth register and maternity database. The first control was the next mother to deliver in the hospital, representing the normal population of mothers. The second control was the next mother to deliver an unaffected child whose age was within one year of that of the index case controlling for maternal age. RESULTS: There was a strong inverse association between maternal age and gastroschisis. An inverse association between gastroschisis and birth order was eliminated by adjustment for maternal age. The average age of mothers of affected children was 22.1 years; of the next delivery control was 28.8 years, and of the age matched control was 22.2 years. A weak non-statistically significant negative association between BMI and gastroschisis was further weakened by adjustment for maternal age. CONCLUSION: Our results confirm the previously reported association between low maternal age and gastroschisis but suggest that within our UK population the link between low BMI and gastroschisis reported elsewhere is explained by younger mothers being thinner.