Cesarean Wound Closure in Women With BMI 40 or Greater

NCT ID: NCT02549131

Last Updated: 2022-08-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

232 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-30

Study Completion Date

2021-01-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Suture

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

Group Type ACTIVE_COMPARATOR

Randomizing to Suture or Staple closure of Cesarean section

Intervention Type PROCEDURE

Randomizing to either surgical subcuticular suture or surgical staples in women of BMI greater than 40 undergoing Cesarean section delivery.

Staples

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.

Group Type ACTIVE_COMPARATOR

Randomizing to Suture or Staple closure of Cesarean section

Intervention Type PROCEDURE

Randomizing to either surgical subcuticular suture or surgical staples in women of BMI greater than 40 undergoing Cesarean section delivery.

Interventions

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Randomizing to Suture or Staple closure of Cesarean section

Randomizing to either surgical subcuticular suture or surgical staples in women of BMI greater than 40 undergoing Cesarean section delivery.

Intervention Type PROCEDURE

Other Intervention Names

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suture or staples for skin closure

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Banner Health

OTHER

Sponsor Role collaborator

Pediatrix

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jordan Perlow, MD

Role: PRINCIPAL_INVESTIGATOR

Pediatrix

Locations

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Banner University Medical Center - Phoenix

Phoenix, Arizona, United States

Site Status

University of Colorado Denver

Aurora, Colorado, United States

Site Status

Countries

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United States

References

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Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol. 2013 Oct;209(4):294-306. doi: 10.1016/j.ajog.2013.02.043. Epub 2013 Mar 1.

Reference Type BACKGROUND
PMID: 23467047 (View on PubMed)

ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009 Jun;113(6):1405-1413. doi: 10.1097/AOG.0b013e3181ac0544. No abstract available.

Reference Type BACKGROUND
PMID: 19461456 (View on PubMed)

Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002 Nov;100(5 Pt 1):959-64. doi: 10.1016/s0029-7844(02)02323-2.

Reference Type BACKGROUND
PMID: 12423861 (View on PubMed)

Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010 Sep;203(3):271.e1-7. doi: 10.1016/j.ajog.2010.06.049. Epub 2010 Aug 3.

Reference Type BACKGROUND
PMID: 20678746 (View on PubMed)

Conner SN, Verticchio JC, Tuuli MG, Odibo AO, Macones GA, Cahill AG. Maternal obesity and risk of postcesarean wound complications. Am J Perinatol. 2014 Apr;31(4):299-304. doi: 10.1055/s-0033-1348402. Epub 2013 Jun 13.

Reference Type BACKGROUND
PMID: 23765707 (View on PubMed)

Mackeen AD, Devaraj T, Baxter JK. Cesarean skin closure preferences: a survey of obstetricians. J Matern Fetal Neonatal Med. 2013 May;26(8):753-6. doi: 10.3109/14767058.2012.755509. Epub 2013 Jan 11.

Reference Type BACKGROUND
PMID: 23211124 (View on PubMed)

Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003 Feb;9(2):196-203. doi: 10.3201/eid0902.020232.

Reference Type BACKGROUND
PMID: 12603990 (View on PubMed)

Pevzner L, Swank M, Krepel C, Wing DA, Chan K, Edmiston CE Jr. Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery. Obstet Gynecol. 2011 Apr;117(4):877-882. doi: 10.1097/AOG.0b013e31820b95e4.

Reference Type BACKGROUND
PMID: 21422859 (View on PubMed)

McLean M, Hines R, Polinkovsky M, Stuebe A, Thorp J, Strauss R. Type of skin incision and wound complications in the obese parturient. Am J Perinatol. 2012 Apr;29(4):301-6. doi: 10.1055/s-0031-1295637. Epub 2011 Nov 21.

Reference Type BACKGROUND
PMID: 22105439 (View on PubMed)

Thornburg LL, Linder MA, Durie DE, Walker B, Pressman EK, Glantz JC. Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery. J Matern Fetal Neonatal Med. 2012 Sep;25(9):1544-8. doi: 10.3109/14767058.2011.653422. Epub 2012 Feb 13.

Reference Type BACKGROUND
PMID: 22233403 (View on PubMed)

Other Identifiers

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Cesarean Closure

Identifier Type: -

Identifier Source: org_study_id

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