What's the right time for dressing in a cesarean wound? Early versus late dressing removal in cesarean wound

Abstract

Aim and objective of study To study the benefits and risks of early (within post cesarean section day 4 th) versus late (after 8 th day post cesarean section) dressing removal in caesarean wound. Material and Method It was a prospective and randomized, controlled study which was conducted over a period of six months November 2019 to April 2020 at a tertiary care center in the department of Obstetrics and Gynecology, ESI PGIMSR Basaidarapur, New Delhi. The antenatal woman aged between 18 years to 40 years who underwent caesarean section were included in study. The cases with obstructed labor, chorioamnionitis, intrauterine death and fever were excluded from study. Women who agreed to participate and gave a written informed consent were enrolled in study. A detailed explanation, both verbal and written, was given by investigator to the patients prior to recruitment. After the caesarean section, in both elective and emergency cesarean, rectus was closed with vicryl suture. The subcutaneous area was washed with betadine. The skin was closed with either Monocryl or silk. After closure, the wound was cleaned with betadine. The wound was covered with two pieces of sterile gauze piece and water proof adhesive bandage or plaster was applied all over the wound. Per-operative antibiotics (based on the Institute protocol) were continued for 5 days or more depending on comorbidities. The women were assigned in groups randomly. The Group A-Early dressing removal: The dressings were opened on post caesarean section day 4 th and Group B-Late dressing removal the dressing was opened after 8 th day post caesarean section. The sutures were removed on 10 th to 12 th day post cesarean section. The wound was assessed for healing and presence of infection according to ASEPSIS score [7]. The ASEPSIS is a quantitative scoring method that provides a numerical score related to the severity of wound infection using objective criteria based on wound appearance and the clinical consequences of the infection. Severity of impaired wound healing is indicated by the total score as follows: satisfactory healing 0 to 10; disturbance of healing 11 to 20; minor wound infection 21 to 30; moderate wound infection 31 to 40; and severe wound infection more than 40. Statistical Analysis The presentation of the Categorical variables was done in the form of number and percentage (%). On the other hand, the presentation of the continuous variables was done as mean ± SD and median values. The data normality was checked by using Kolmogorov-Smirnov test. The cases in which the data was not normal, we used non parametric tests. The following statistical tests were applied for the results: 1. The comparison of the variables which were quantitative in nature were analyzed using Mann-Whitney Test. 2. The comparison of the variables which were qualitative in nature were analyzed using Chi-Square test. The data entry was done in the Microsoft EXCEL spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. For statistical significance, p value of less than 0.05 was considered as significant. The primary outcome parameters studied were ASEPSIS Wound Score.