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Further debate about the effect of incisional negative pressure wound therapy (iNPWT) versus standard wound dressing on surgical-site infection (SSI) in obese women after caesarean section (CS) has resurfaced. This is because of a study published in JAMA1 that was stopped early on the grounds of "futility". This was counterintuitive to us having published a systematic review,2 a randomised controlled trial (RCT)3 and a health economic evaluation on the same subject,4 the latter two of which were published in BJOG.

Objective To evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section. Design Multicentre randomised controlled trial. Setting Five hospitals in Denmark. Population Obese women (prepregnancy body mass index (BMI) ≥30 kg/m2) undergoing elective or emergency caesarean section. Method The participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention‐to‐treat. Blinding was not possible due to the nature of the intervention. Main outcome measures The primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health‐related quality of life. Results Incisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30–0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups. Conclusion Prophylactic use of incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women giving birth by caesarean section. Tweetable abstract RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI., Tweetable abstract RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.

Objective To examine the experience of women with a pre-pregnant BMI >30 kg/m2, in their encounters with healthcare professionals during pregnancy. Design Qualitative study using a phenomenological methodology approach. Setting Face-to-face interviews with pregnant women in their own home who were referred from their general practitioner to specialist antenatal follow-up at their local hospital. Sample Sixteen women with pre-pregnant BMI >30 kg/m2. Methods Qualitative in-depth interviews. Participant's experiences of their encounters with health care professionals were recorded verbatim, transcribed and analysed using a phenomenological approach. Results Two main themes were identified, an accusatorial response from healthcare professionals and a lack of advice and helpful information on how being obese and pregnant might affect the women's health and that of their child. Conclusions Pregnant women with obesity may experience prejudice from healthcare professionals. These women felt they were treated with a lack of respect, an accusatorial response, and the feeling that information which could have been helpful was not forthcoming. Communication between obese pregnant woman and healthcare professionals appears to be lacking. Improved training in communication skills, less judgemental behaviour and better dissemination of information from healthcare professionals working with pregnant women with obesity are needed.

Background. Approximately 1–2% of women suffer from post-traumatic stress disorder (PTSD) postnatally. This review aims to elucidate how women at risk can be identified. Methods. A systematic search of the published literature was carried out using the MEDLINE database (November 2003 to 29 October 2010) with both MeSH terms and free text. Thirty-one studies were considered appropriate for qualitative synthesis. Articles were included on the basis of (a) publication pertaining to PTSD following childbirth, (b) study carried out in Western Europe and (c) publication written in English. The results were primarily based on observational studies. The literature was thoroughly read and results were compiled. Furthermore, a novel quality rating system was employed to minimize the impact of bias. Results. Subjective distress in labor and obstetrical emergencies were the most important risk factors. Infant complications, low support during labor and delivery, psychological difficulties in pregnancy, previous traumatic experiences, and obstetrical emergencies were identified as risk factors. Conclusions. We have identified factors both strongly associated and non-associated with PTSD following childbirth. While the literature is limited by methodological shortcomings, a hypothesis regarding the development of PTSD is outlined, and recommendations with respect to screening and future research are provided.