Use of Monocryl for subcutaneous skin closure minimizes wound complications in cesarean sections

courtesy: https://www.esutures.com/product/images/full/IMG-6441.jpg

courtesy:http://media.xn--benersttning-lcb.se/2012/05/vicryl1.jpg

Subcuticular skin closure after cesarean delivery with poliglecaprone 25 suture IMONOCRYL) decreases the rate of cesarean wound complications by 39% as compared with polyglactin 910 suture (Coated VICRYL) says the result of randomized control trial published ahead of print in Journal Obstetrics and Gynecology.

Monocryl is monofilament, absorbable suture which dissolves slowly and loses strength while Vicryl is braided, absorbable suture that dissolves quickly but maintain strengths.

The type of skin suture and rate of wound infection after cesarean section has not been widely studied. In this study, the researchers compared the two sutures in term of subsequent wound complication rates (SSI, hematoma, seroma, wound separation) after a cesarean section through a Pfannenstiel skin incision followed by subcuticular closure.

This single center RCT conducted at Montefiore Medical Center, New York recruited about 520 women over a course of 1.25 years. About 263 women were randomized to receive the wound closure with monocryl while in 209 women the wound was closed with vicryl.

The groups were similar in terms of demographics, medical comorbidities and perioperative characteristics. They were followed up for a period of 30 days for wound gaping of > 1 cm in length, hematoma or seroma and surgical site infections as per Centers for Disease Control and Prevention criteria’s.

Use of monocryl was associated with significant less infection as compared to vicryl (8.8% compared with 14.4% (relative risk 0.61, 95% CI 0.37-0.99; P=.04).

The researchers concluded that,” Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of wound complications compared with polyglactin 910 suture.”

The study was also presented at the 37th annual meeting of Society for Maternal-Fetal Medicine, January 23-28 Las Vegas.

Novel Cesarean Section Scalpel that increases fetal safety during surgery unveiled.

Sureglide cesarean scalpel 

Ecomed Solutions, developer and manufacturers of unique healthcare solutions unveiled its Sureglide™ Cesarean scalpel at the Society for Maternal-Fetal Medicine’s 37th Annual Pregnancy Meeting in Las Vegas.

The scalpel has got superior ergonomics and protected blade design that is meant to protect fetuses, surgeons and other staff of operating room against cuts and lacerations.

It was designed by engineers and ob-gyn together, keeping in mind to eliminate fetal skull lacerations during C-sections. The device houses a protected blade that cuts up and away from the fetus. The handle offers same grip as traditional scalpel, but greater control and at the same time protecting the fetus and surgeon both.

David Yurek CEO of Ecomed solutions termed it as“a unique safety device specifically designed for C-sections.”

The concepts were developed by using clay to model the scalpel transferring to a 3D CAD modeling software to use 3D printing technology to create a prototype.

“The most stressful aspect of a delivery for every doctor is getting the baby out safely,” explained Dr. Andrea Wolfe, a top-rated ob-gyn practitioner based in Grand Rapids, Michigan and medical consultant for Sureglide. “Just like the mother and father, we invest 9 months in preparing for the most precious moment of a family’s life. With Sureglide, a doctor is assured that every risk is managed right up to the last moment in pregnancy.”

In US. The current C-section rate  is 30%,  which also increases the number of fetal injuries, which according to data from  National Institutes of Health (NIH)  occurs in 3% of cases .Most often the babies face, cheek or ear is under the hysterotomy scar.

A video of how Sureglide  works can be seen at the company's site. Click here to watch the demonstration video. 

Source:

http://www.ecomed-solutions.com/sureglide-physicians.html

Mother’s Cervicovaginal microbiota could be the key to prevent Spontaneous Preterm Births--News from SMFM 2017, Las Vegas.

Courtesy: CDC

More exciting news from the pregnancy meeting, SMFM 2017, Las Vegas. Researchers have identified that maternal cervicovaginal (CV) flora plays an important role in timing of delivery, it could increase or prevent the risk of Spontaneous Preterm Births (SPTB).  

The study abstract was presented on January 26,2017 at the meeting and won the March of Dimes award for best abstract on prematurity.

This was a nested study of a large project called as “Motherhood and the Microbiome” that was funded by National Institute of Nursing Research (NINR). This is a large observational, prospective study of women with a term birth undergoing follow up for Preterm Births.

Dr. Elovitz, professor of Obstetrics and Gynecology at the University of Pennsylvania, vice chair of Translational Research and Director of the Maternal and Child Health Research Center at PENN University and his colleagues worked on the hypothesis that preterm birth occurs because of some changes at molecular, anatomical and microbial level in the cervicovaginal space that are different in women who have a SPTB vs. women who deliver at term.

The study recruited about 1500 patients and collected cervicovaginal specimens at 3 time points throughout pregnancy. From this larger pool of participants, 80 cases with SPTB and 320 term controls were matched and analyzed. 16S rRNA gene analyses was used to identify bacterial specimens.

Additionally, in 616 patients single sample was collected to serve as validation.

Presence of Bifidobacterium species in the cervicovaginal space was highly protective for SPTB at all time while BV-associated bacteria (BVABs) and Mobiluncus were associated with statistically significant rise in SPTBs. (p<0.0001).

Edward R.B. McCabe, MD, PhD, senior vice president and chief medical officer of the March of Dimes said “From these data, we may learn how to prevent preterm birth either by eliminating the CV bacteria that are associated with an increased risk and/or by enhancing the presence of protective bacteria. This is a promising new area that should become a research priority.”

The best agent to prevent preeclampsia: A systematic review and network meta-analysis--News from SMFM 2017, Las Vegas.

Calcium supplements 

Out of various agents used for prevention of preeclampsia calcium supplementation has got the highest likelihood of being successful in bringing down its incidence and perinatal mortality as per a study presented by Sanchez-Ramos L. et al. at the pregnancy meeting, SMFM 2017, Las Vegas.

Preeclampsia complicates approximately 3-5% of pregnancies, accounting for 10-15% of maternal deaths and 3% of perinatal deaths.

Numerous agents have been studied for their ability to prevent preeclampsia and conventional studies have gauged the effectiveness of these agents. But these have been small, single center trials.

This was a systematic review and network meta-analysis of large RCTs comparing the effectiveness of multiple treatment options in preventing preeclampsia. Only data from meta-analysis of large RCTs with more than 450 subjects were included.

The study was registered under PROSPERO,[1] an international prospective register of systematic reviews in areas of healthcare all around the world and guided by PRISMA guidelines.[2]

A search of electronic databases from 1966 through July15, 2016 picked up 27 large multicenter trials with total of 60, 425 pregnant women. This large cohort was used to compare various exposures against Placebo or no treatment for the development of preeclampsia. The secondary outcome studied were severity of preeclampsia and maternal and neonatal morbidity and mortality. The various agents studied were:

• Low-dose aspirin: aspirin given at low doses (50-100mg) during pregnancy
• Calcium supplementation: given at doses of 500-2000mg
• Low molecular weight heparin: anticoagulant
• Vitamin E/C: vitamin supplements in varying doses as defined by the study
• Fish oil: supplement derived from fatty tissue of fish containing omega-3 fatty acids

Direct and indirect pairwise comparison was done using STATA for multivariate random effect models.

It was seen that women who regularly received Calcium supplementation had a 61% and 74% less odds of developing preeclampsia in direct and indirect comparison.

Women receiving calcium supplementation has 68% less likelihood of developing preeclampsia as compared to women receiving fish oil.  

Taking Calcium was also associated with less chances of perinatal mortality as compared to low-dose aspirin, vitamins C & E, and placebo. 

---

[1] https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-1-2

[2] http://www.prisma-statement.org/

Model developed to predict chances of vaginal delivery in nulliparous women undergoing induction of labor-- News from SMFM 2017, Las Vegas.

 

According to statistics by CDC, 23.3% of women in USA undergo induction of labor making it one of the most common obstetric procedure performed in US hospitals.

A study presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas by Dr. Tetsuya Kawakita and his colleagues sought to  develop a model that could predict  the likelihood of successful induction of labor. [1]

The researchers used data from Consortium on Safe labor study, a retrospective multicenter study that extracted data on labor and delivery across 19 hospitals in United states. [2]

Of 12,413 nulliparous women at ≥37 weeks’ gestation who had labor undergone induction, 9,550 (76.9%) delivered vaginally.

The researchers studied the various demographic, obstetric and neonatal factors in these study group and by running stepwise logistic regression were able to identify factors associated with successful vaginal birth.

The maternal factors were maternal age, BMI, race, weeks at induction, gestational diabetes or prediabetes, cervical dilatation, effacement and consistency.  Fetal factors were station of fetal head, amount of liquor, IUGR and CTG at the beginning of the procedure. Taking all these factors into account a Nomogram was created, each maternal factor was allotted a fixed number of points. A maternal BMI of 70 received 8 points while a BMI of 20 received 95 points. Similarly, if maternal age at labor was 45 she received 4 points while 25 points were given if her age was 20.

The total points were calculated with a maximum of 317 points. The higher the number of points the patient received, the probability of vaginal delivery also increased.  

Adapted from SMFM 2017 abstracts 

---

[1] http://www.ajog.org/article/S0002-9378(16)31917-2/fulltext

[2] https://www.nichd.nih.gov/about/org/diphr/eb/research/Pages/safe-labor.aspx

Similar results obtained after use of Glue or subcutaneous Monocryl for cesarean wound closure -- News from SMFM 2017, Las Vegas.

Skin glue: Ethicon.com 

Monocryl 

Use of Glue(Dermabond ) or subcutaneous  Monocryl results in same outcome in terms of safety, healing,  wound complications or cosmetic appearance. The choice of using one over another depends on surgeons’ choice and patient’s preference.

The study will be presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas. Cesarean sections rates are on rise, it is the most common surgery performed in U.S. hospitals. Roughly, every one in three baby is born by Cesarean Section. In-spite this, there is still no consensus or evidence about best method for skin closure in Cesarean section.

Yari Daykan and his colleagues from Dept. of Obstetrics and Gynecology at Meir Medical Center in Kfar Saba and the Sackler School of Medicine in Tel Aviv conducted a RCT, in which women undergoing a scheduled Cesarean section were randomized to either have the wound glued using Dermabond or wound closed by using subcuticular Monocryl. [1]

The scars were assessed after 2 months by using Patient and Observer Scar Assessment Scale (POSAS) scores.   The POSAS is a comprehensive scale that is designed for the evaluation of all types of scars by professionals and patients.[2]

The scar site was also evaluated at 1 month for infection, discharge, redness or dehiscence as secondary outcome of the study.

Both the study groups were comparable in terms of indications for C-section, length of surgery, BMI and other demographics.

It was seen that at 8 weeks, scars were comparable in terms of patient score, physician score and subcutaneous thickness, wound infection or wound dehiscence.

Researchers concluded that both methods are safe, equally effective and the choice depends on surgeon and patient's preferences.

---

[1] http://www.smfmnewsroom.org/2017/01/skin-closure-options-for-cesarean-delivery-glue-versus-subcuticular-sutures/#more-1584

[2] http://www.posas.org/

Use of Monocryl suture minimizes wound complications in cesarean sections - News from SMFM 2017, Las Vegas.

courtesy: https://www.esutures.com/product/images/full/IMG-6441.jpg

courtesy:http://media.xn--benersttning-lcb.se/2012/05/vicryl1.jpg

Use of poliglecaprone 25 (Monocryl) subcutaneous suture for abdominal wound closure in Cesarean Section reduces the wound complication rate by nearly 50 % as compared to use of polyglactin 910 (coated Vicryl) according to a study that will be presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas.[i]

Monocryl is monofilament, absorbable suture which dissolves slowly and loses strength while Vicryl is braided, absorbable suture  that dissolves quickly but maintain strengths.

The first ever Randomized control trial was conducted by Dr. Arin Buresch and her colleagues from Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.[ii]

Over a course of little more than a year, 550 patients undergoing non-emergency cesarean section were recruited and randomly allocated to either receive poliglecaprone(275() or 275 receiving polyglactin for subcutaneous wound closure of the Pfannenstiel abdominal incision.

The groups were comparable demographically. These patients were evaluated and compared at 30 days for wound gaping of > 1 cm in length, hematoma or seroma and surgical site infections as per Centers for Disease Control and Prevention criteria’s.

8.8% patient had wound complication in poliglecaprone 25 (Monocryl) group as opposed to 14.4% patient in Vicryl group (p=.04).

Dr. Arin Buresch concluded “The difference in wound complications may occur due to the braiding in vicryl suture which conceivably allows bacterial growth in small nooks and crevices. In the future, we hope our study will help guide the decision-making on which suture type is used when closing the skin in cesarean births.”

---

[i] https://www.smfm.org/meetings/2-37th-annual-pregnancy-meeting/registration

[ii] http://www.smfmnewsroom.org/2017/01/comparing-skin-closure-options-for-cesarean-delivery-to-determine-which-method-causes-the-least-wound-complications/#more-1609