Comparative Study Between Subcutaneous Tissue Closure Versus Drain in Obese Women Undergo Elective Cesarean Section

NCT ID: NCT04177381

Last Updated: 2025-06-25

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

352 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-04

Study Completion Date

2022-11-02

Brief Summary

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Randomised cinical trial in Kasr Alainy Hospital.352 obese women pregnant with gestational age \>38 wk ,theire age range from (25-35) years and BMI between (30 -40) undergoing elective cesarean section were randomised into 4 groups and compare the role of subcutaneous tissue closure in post cesarean section wound complications.

groups are: 4 groups each group was 86 women : A -interrupted closure of subcutaneous tissue with drain ( a closed nonvacuum drain was inserted in the tissue and exite from the skin through a separate opening and stitch to the skin) .

B-interrupted closure of subcutaneous tissue without drain. c- non closure of subcutaneous tissue with drain only. d- non closure of subcutaneous tissue without drain.

All womenu nder going CS with Pfannenstiel incision were considered to be eligible if time allowed informed consent before the surgery

Detailed Description

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Randomised cinical trial in Kasr Alainy Hospital.352 obese women pregnant with gestational age \>38 wk ,their age range from (25-35) years and BMI between (30 -40) undergoing elective cesarean section were randomised into 3 groups (100 patients in each group)and compare the role of subcutaneous tissue closure in post cesarean section wound complications.

4 groups are:: A -interrupted closure of subcutaneous tissue with drain ( a closed nonvacuum drain was inserted in the tissue and exit from the skin through a separate opening and stitch to the skin) .

B-interrupted closure of subcutaneous tissue without drain. c- non closure of subcutaneous tissue with drain only. d- non closure of subcutaneous tissue without drain.

All women under going CS with Pfannenstiel incision were considered to be eligible if time allowed informed consent before the surgery All surgical procedures were performed by obstetric and gynecology residents under the supervision of attending physicians After the sequential closure of the uterus and peritoneum, the fascia was closed with 2-0 polyglactin 910 (Vicryl). The depth of the subcutaneous adipose tissue was measured with a sterile ruler from the fascia to the skin edge at the middle of the superior aspect of the skin incision.Women with a subcutaneous tissue thickness of 4.0 cm or more were then formally enrolled and randomized to one of the two subcutaneous closure techniques. Subcutaneous hemostasis were achieved using electrocautery and skin was approximated with subcuticular suture using 2-0 polyglactin910 (VicrylRapide).company city country In the drain group, a closed nonvacuum drain was inserted in the tissue and exite from the skin through a separate opening and stitch to the skin (Al Allair 2000). company city country The drain was left until the drainage rate was less than 30 ml/day or after 72h .( The skin was closed with a continuous nonabsorbable polypropylene 2/0 (Acufirm; Ernst Kratz, Germany) subcuticular sutures. Operative time was estimated from the start of skin incision until the end of skin suturing. The drain was left until the drainage rate was less than 50 ml/day.

All randomized women received standard postoperative wound care. Surgical dressing was removed on the first postoperative and all participants were discharged 24 h after the CS. The participants were invited to two follow-up in the first and second week post operative with regard to postoperative pain, postoperative fever, hospital stay duration, wound infection, wound seroma, wound disruption, and the need for redressing. The postoperative pain was judged after 24 h using visual analogue scale, in addition any time clinically indicated. Patients and physicians who assessed the incision postoperatively were blinded towards the study group.

Conditions

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Wound Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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interrupted closure of subcutaneous tissue with drain

consist of 89 patients that will be allocated for interrupted closure of subcutaneous tissue with drain

Group Type ACTIVE_COMPARATOR

Cesarean section

Intervention Type PROCEDURE

1. Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
2. The fascia will be then incised sharply at the midline
3. The transversalis fascia and pre peritoneal fat will be dissected carefully
4. The peritoneum will be then incised.
5. Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
6. Delivery of the Fetus and placenta.
7. Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.

subcutanous sutures

Intervention Type PROCEDURE

suture closure of subcutaneous tissue with interrupted 2-0 polyglactin 910 (Vicryl).the stitch interval is 1cm

subcutanous drain

Intervention Type DEVICE

Inthedraingroup,aclosednonvacuum drain willbeinsertedin thetissueandexitefrom theskinthroughaseparateopeningandstitchto theskin

interrupted closure of subcutaneous tissue without dra

consist of 88 patients that will be allocated for interrupted closure of subcutaneous tissue without drain

Group Type ACTIVE_COMPARATOR

Cesarean section

Intervention Type PROCEDURE

1. Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
2. The fascia will be then incised sharply at the midline
3. The transversalis fascia and pre peritoneal fat will be dissected carefully
4. The peritoneum will be then incised.
5. Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
6. Delivery of the Fetus and placenta.
7. Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.

subcutanous sutures

Intervention Type PROCEDURE

suture closure of subcutaneous tissue with interrupted 2-0 polyglactin 910 (Vicryl).the stitch interval is 1cm

non closure of subcutaneous tissue with drain

In the drain group,a closed non vacuum drain will be inserted in the tissue and exit from the skin through a separate opening and stitch to the skin

Group Type ACTIVE_COMPARATOR

Cesarean section

Intervention Type PROCEDURE

1. Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
2. The fascia will be then incised sharply at the midline
3. The transversalis fascia and pre peritoneal fat will be dissected carefully
4. The peritoneum will be then incised.
5. Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
6. Delivery of the Fetus and placenta.
7. Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.

subcutanous drain

Intervention Type DEVICE

Inthedraingroup,aclosednonvacuum drain willbeinsertedin thetissueandexitefrom theskinthroughaseparateopeningandstitchto theskin

non closure of subcutaneous tissue and no drain

87 women without subcutanous sutures and without drain

Group Type ACTIVE_COMPARATOR

Cesarean section

Intervention Type PROCEDURE

1. Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
2. The fascia will be then incised sharply at the midline
3. The transversalis fascia and pre peritoneal fat will be dissected carefully
4. The peritoneum will be then incised.
5. Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
6. Delivery of the Fetus and placenta.
7. Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.

Interventions

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Cesarean section

1. Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
2. The fascia will be then incised sharply at the midline
3. The transversalis fascia and pre peritoneal fat will be dissected carefully
4. The peritoneum will be then incised.
5. Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
6. Delivery of the Fetus and placenta.
7. Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.

Intervention Type PROCEDURE

subcutanous sutures

suture closure of subcutaneous tissue with interrupted 2-0 polyglactin 910 (Vicryl).the stitch interval is 1cm

Intervention Type PROCEDURE

subcutanous drain

Inthedraingroup,aclosednonvacuum drain willbeinsertedin thetissueandexitefrom theskinthroughaseparateopeningandstitchto theskin

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* obese women who BMI(30- 40 kg/m2)
* Gestational age (37-41) week calculated by sure dates and confirmed by first trimester US,
* single fetus.
* Elective lower segment cesarean section

Exclusion Criteria

* Any medical disorders affect wound healing as:
* Diabetes mellitus.
* On steroids.
* Immunedeficiency.
* Hypoalbuminemia.
* Skin infections or history of wound infections.
* Multifetal pregnancy.
* Obstetric complications eg.placenta previa.
* Anemia.
* Intraoperative complications as intestinal injury or bladder injury
Minimum Eligible Age

25 Years

Maximum Eligible Age

35 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Ahmed M Maged, MD

professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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ahmed maged

Role: STUDY_DIRECTOR

professor

Locations

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Kasr Alainy medical school

Cairo, , Egypt

Site Status

Countries

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Egypt

References

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Shalaby MA, Metwally HHM, Maged AM, Bayoumi YA, Salah N. The value of subcutaneous tissue closure and drain in obese women undergo elective caesarean section: a randomized controlled trial. BMC Pregnancy Childbirth. 2025 May 5;25(1):534. doi: 10.1186/s12884-025-07579-z.

Reference Type DERIVED
PMID: 40325365 (View on PubMed)

Other Identifiers

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171

Identifier Type: -

Identifier Source: org_study_id

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