Subcutaneous tissue closure and postoperative wound complications in cesarean delivery: A systematic review and meta-analysis.

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-06-18 DOI:10.1016/j.ajogmf.2025.101724

Giulia Bonanni, Vivian Nguyen, Marta Francescutti, Alireza A Shamshirsaz, Vincenzo Berghella

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引用次数: 0

Abstract

Objective: The benefit of subcutaneous tissue closure during cesarean delivery (CD) has been well established in pregnant individuals with a subcutaneous tissue thickness greater than 2 cm. However, its routine application in all pregnant individuals remains a contentious topic. This meta-analysis aimed to evaluate and quantify the effect of subcutaneous tissue closure compared to non-closure on postoperative wound complications in all patients undergoing CD.

Data sources: We searched PubMed, EMBASE, Web of Science, Medline, Scopus, Cochrane Central Register of Clinical Trials, and ClinicalTrials.gov from their inception to October 2024 for randomized controlled trials (RCTs).

Study eligibility criteria: Eligible studies included RCTs comparing subcutaneous tissue closure versus non-closure in patients undergoing CD. Studies were excluded if they focused solely on selected subpopulations, such as pregnant individuals with subcutaneous fat >2 cm or those classified as obese. Primary outcomes were seroma formation, hematoma, surgical site infection (SSI), and wound dehiscence. Secondary outcomes included postoperative pain and cosmetic results.

Study appraisal and synthesis methods: Random-effects models were used to calculate relative risks (RR) for each outcome. Heterogeneity across studies was assessed using the I² statistic.

Results: Eight trials comprising 1,854 participants (918 closure, 936 non-closure) met inclusion criteria. There were no significant differences between groups for SSI (RR 0.95, 95% CI: [0.69-1.31]), dehiscence (RR 0.64, 95% CI: [0.21-1.98]), seroma (RR 0.87, 95% CI: [0.05-14.81]), hematoma (RR 0.54, 95% CI: [0.02-15.90]), or composite wound outcomes (RR 1.05, 95% CI: [0.80-1.38]). Study heterogeneity was low (I² < 45%).

Conclusions: Subcutaneous tissue closure during CD does not significantly reduce the risk of wound complications when applied universally. These findings do not support its routine implementation for all patients with subcutaneous thickness less than 2 cm. Further research should focus on refining patient selection criteria and evaluating other potential benefits, including long-term cosmetic outcomes.

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剖宫产中皮下组织闭合和术后伤口并发症：一项系统回顾和荟萃分析。

目的：对于皮下组织厚度大于2厘米的孕妇，剖宫产（CD）期间皮下组织闭合的益处已经得到了很好的证实。然而，它在所有怀孕个体的常规应用仍然是一个有争议的话题。本荟萃分析旨在评估和量化所有cd患者皮下组织闭合与非闭合对术后伤口并发症的影响。数据来源：我们检索了PubMed， EMBASE, Web of Science, Medline, Scopus， Cochrane Central Register of ClinicalTrials和ClinicalTrials.gov，从其成立到2024年10月的随机对照试验（rct）。研究资格标准：符合条件的研究包括比较CD患者皮下组织闭合与非闭合的随机对照试验。如果研究只关注选定的亚群，如皮下脂肪超过2厘米的孕妇或被归类为肥胖的人，则排除研究。主要结局是血肿形成、血肿、手术部位感染（SSI）和伤口裂开。次要结果包括术后疼痛和美容结果。研究评价和综合方法：采用随机效应模型计算各结果的相对风险（RR）。使用I²统计量评估各研究的异质性。结果：8项试验包括1854名受试者（918名结束，936名未结束）符合纳入标准。SSI （RR 0.95, 95% CI:[0.69-1.31]）、裂开（RR 0.64, 95% CI:[0.21-1.98]）、血肿（RR 0.87, 95% CI:[0.05-14.81]）、血肿（RR 0.54, 95% CI:[0.02-15.90]）或复合伤口结局（RR 1.05, 95% CI:[0.80-1.38]）组间无显著差异。研究异质性低（I²< 45%）。结论：CD期间皮下组织闭合在普遍应用时不能显著降低伤口并发症的风险。这些发现并不支持常规应用于所有皮下厚度小于2厘米的患者。进一步的研究应该集中在完善患者选择标准和评估其他潜在的好处，包括长期的美容效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.