Intervention for Postpartum Infections following Caesarean Section

Purpose: To examine the effect on wound healing, using Negative Pressure Wound Therapy (NPWT) compared with standard wound dressings in women, who experience spontaneous dehiscence or reoperation due to infection or hematoma after caesarean section. In addition, an analysis of the health economic cost and consequences of NPWT is planned.Methods: A randomized controlled trial. The study will be performed at two large obstetrical units in Denmark. Data will be collected prospectively. We expect to include 50 women, of whom two-thirds will be randomized to NPWT. The primary endpoint is the frequency of re-rupture in each group. The secondary endpoints are a cosmetic outcome score and a Quality of Life score.Preliminary results: Fifteen women have so far been included, of whom 93% were re-sutured as scheduled on the fourth day postoperatively, 0% experience re-rupture and 7% healed subsequently from the inside. By comparison a review of medical records from 2008 to mid-2010 found that out of 19 women 58% were re-sutured, 21% experience re-rupture and 30% healed from the inside. 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.Concussion: The preliminary results indicate that NPWT reduce the risk of re-rupture significantly. The benefit of the treatment is expected to be twofold:a) A reduction in health care costs (inpatient bed days and readmissions)b) An increase in the women's health related quality of life