Closing Caesarean with Metal Staples Doubles Risk of Infection

pregnant mum.jpgA recent meta analysis report found that wound complications (infection) occur twice as often when a caesarean section birth (using a transverse cut) is closed with metal staples rather than subcuticular sutures.

It takes less time to close the skin with staples (estimated time saved ranged from 3.3 to 9.3 minutes), but the time saved resulted in more wound complications. The findings from this analysis will surely encourage surgeons to choose the method with the fewest complications rather than aiming to save time.

Wound infection is one complication that prevents a woman from successfully birthing vaginally after a caesarean section (VBAC). When a woman decides on a VBAC, the risk of uterine rupture is increased with infection of a previous caesarean wound (also with a prior vertical incision caesarean, two or more caesareans, single layer closure of the uterus, induction of labour, use of prostaglandins, and a shorter interval between pregnancies). Wound infection is associated with more internal adhesions after pelvic surgery. Adhesions are bands of collagen the body produces to start healing immediately after surgery, infection, trauma or inflammation.

Complications occur when adhesions cause tension and restricted mobility between internal structures that are not usually connected. Post-surgical adhesions joining any area in the pelvis or abdomen to another structure (muscles, organs, bones, nerves, blood vessels) are likely to cause unusual pain and dysfunction.

In future pregnancies, pain may be felt as the growing uterus stretches and breaks adhesions between the uterus, other organs or the abdominal wall. The risk of placental attachment to the uterine scar site increases with each caesarean birth; making the surgery more complicated for the surgeon with increased time spent dividing scarring and adhesions from prior surgery.

Adhesions between the uterus, ovaries or fallopian tubes cause pelvic, back and intercourse pain or infertility when the egg and sperm are obstructed from travelling along the fallopian tube. Adhesions forming around the small intestine cause pain, diarrhoea, constipation or an irritable bowel, and occasionally, obstruction.

When a caesarean birth is advised for the safety of mother and child, avoiding metal sutures will lower the risk of wound infection and increased adhesions.

Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-Analysis. Tuuli, Methodius G. MD, MPH; Rampersad, Roxane M. MD; Carbone, Jeanine F. MD; Stamilio, David MD, MSCE; Macones, George A. MD, MSCE; Odibo, Anthony O. MD, MSCE. O&G March 2011 - Volume 117 - Issue 3 - pp 682-690doi: 10.1097/AOG.0b013e31820ad61e