Intervention for postpartum infections following caesarean section

The purpose of this study is to examine the effect on wound healing using Negative Pressure Wound Therapy (NPWT) compared with conventional wound treatment in women, who experience spontaneous dehiscence or reoperation for postoperative infection after caesarean section (CS). In addition the study seeks to elucidate the health economic cost and consequences of this type of infection and treatment.Background: Obesity is an increasing problem in the health care system. Today more than 12% of all pregnant women in Denmark are obese (BMI >30). There is a significant association between obesity in pregnant women and the risk of CS. Obesity is associated with an increased risk of postoperative complications such as wound infection, spontaneously dehiscence or reoperation due to infection and prolonged wound healing. Postoperative complications lead to higher costs in the health care sector, including time of health professionals, prolonged hospitalization, medications, blood samples and -cultures, reoperations and visits to the general practitioner. Complications may also lead to productivity losses and reduced quality of life. At Odense University Hospital (OUH), Denmark, the conventional treatment of post-CS infection requires hospital re-admission and re-operation for opening and debridement of the infected wounds under regional- or general anesthesia. The wound is normally re-sutured on the fourth day. NPWT is an alternative method of conservative wound management, which uses negative pressure to promote wound healing in both chronic and acute wounds. The rationale for using NPWT is, that it mechanically stimulates the formation of new tissue and removes wound fluid and infectious material.Methods: A randomized controlled trial with concurrent economic evaluation. In collaboration with the department of plastic surgery at OUH, this study will be performed at two large obstetrical units at OUH and Hvidovre Hospital with more than 10000 deliveries and 2500 CS’s annually. Data will be collected prospectively from 1) self-administered questionnaires 2) registration forms registering used wound dressings. 3) medical records. We expected to include approximately 50 women, of whom two-thirds will be randomized to NPWT.Preliminary results: Four women were included in a pilot project at the obstetrical ward at OUH. Three women were re-sutured as scheduled on the fourth day after the reoperation (two with NPWT and one having the conventional treatment). One woman (NPWT) was re-operated several times and her wound healed subsequently from the inside, which lasted approximately three months. The poor wound healing probably resulting from extreme obesity (BMI >47). An economic calculation has shown that it requires four changes of wound dressing with conventional wound treatment for one change with NPWT to be cost effective. If the change of wound dressing is performed evening or night, the cost increases in the control group due to higher hourly wages.