Abstract:
BACKGROUND:Subcuticular skin closure with suture after cesarean has been shown to result in lower rates of wound complications than with staple closure. However, the optimal choice of suture material for subcuticular skin closure is unclear. Vicryl (a braided multifilament synthetic suture; Ethicon, Somerville, NJ) and Monocryl (a monofilament synthetic suture; Ethicon) are the commonly used suture materials for subcuticular closure of transverse skin incisions after cesarean in the United States. Whereas in vitro and animal studies suggest multifilament suture materials may be associated with a higher risk of wound infection than monofilament sutures, clinical data on their relative effectiveness are limited. OBJECTIVE:We sought to test the hypothesis that Vicryl is associated with a higher rate of wound complications than Monocryl. STUDY DESIGN:This is a secondary analysis of data from a randomized trial in which pregnant women undergoing scheduled or unscheduled cesareans were randomly assigned to preoperative skin preparation with either chlorhexidine-alcohol or iodine-alcohol. Women with low transverse skin incisions who were closed with either 4-0 Monocryl or 4-0 Vicryl were included in this analysis. Choice of suture material was at the discretion of the operating physician. The primary outcome was superficial or deep surgical site infection within 30 days after cesarean. Secondary outcomes were other wound complications. Outcomes were compared between the 2 groups using univariable and multivariable statistics. RESULTS:Of 1082 patients who had follow-up after discharge in the primary trial, 871 had subcuticular suture: 180 with 4-0 Vicryl and 691 with 4-0 Monocryl. Skin closure with Vicryl or Monocryl did not significantly differ between women allocated to chlorhexidine-alcohol or iodine-alcohol (51.1% vs 49.4%, P = .67). There was no significant difference in the risk of surgical site infection in women closed with Vicryl compared with Monocryl (11 [6.1%] vs 35 [5.1%]; P = .58; adjusted odds ratio, 1.23; 95% confidence interval, 0.60-2.49). Rates of other wound complications were also not significantly different. Risks of surgical site infection were similar with Vicryl and Monocryl closure in all subgroups assessed. The relative risks were not materially affected by whether diabetes or obesity was present, cesarean was scheduled or unscheduled, primary or repeat cesarean, or the subcutaneous layer was closed. Post hoc power analysis indicated that we had 80% power to detect >2-fold difference in surgical site infections. CONCLUSION:Subcuticular skin closure with 4-0 Vicryl is associated with comparable rates of surgical site infection and other wound complications as 4-0 Monocryl. While this is an observational study with the potential for selection bias and residual confounding, our results suggest physician preference is acceptable for choice of subcuticular suture material at cesarean.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Tuuli MG,Stout MJ,Martin S,Rampersad RM,Cahill AG,Macones GAdoi
10.1016/j.ajog.2016.05.012subject
Has Abstractpub_date
2016-10-01 00:00:00pages
490.e1-5issue
4eissn
0002-9378issn
1097-6868pii
S0002-9378(16)30207-1journal_volume
215pub_type
杂志文章,随机对照试验abstract::A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the plac...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90514-r
更新日期:1991-03-01 00:00:00
abstract::Umbilical arterial velocity waveforms were recorded in 69 pairs of twins by means of continuous-wave Doppler analysis and an Angioscan spectrum analyzer. A systolic/diastolic ratio was measured for each twin. The sum of the systolic/diastolic ratio was calculated and the difference between each twin was expressed as t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80035-2
更新日期:1987-09-01 00:00:00
abstract::The Reproductive Sciences Branch of the National Institutes of Child Health and Human Development has created pioneering new research and research training programs that address the impending shortage of physician-scientists in obstetrics, gynecology, and women's health and the need to bolster translational and clinic...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.125896
更新日期:2002-10-01 00:00:00
abstract::We describe the preparation and usage of positive and negative quality control standards for the proline aminopeptidase assay of vaginal secretions as an indicator of bacterial vaginosis. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(89)80075-4
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to show and discuss an association between fetal inflammatory response syndrome (FIRS) and an adverse neonatal outcome defined as combined severe neonatal morbidity and mortality in preterm neonates hospitalized in our neonatal intensive care unit. STUDY DESIGN:This was an observati...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.08.030
更新日期:2013-12-01 00:00:00
abstract::All but three of the 270 women surviving eclampsia at the Margaret Hague Maternity Hospital in the period 1931 through 1951 were traced to 1973-74. Seventy-six have died and 13 were not re-examined. In white women having eclampsia in the first pregnancy carried to viability the remote mortality rate is not increased o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90168-x
更新日期:1976-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to test the hypothesis that cocaine alters placental prostaglandin production in vitro. STUDY DESIGN:Placentas were obtained from healthy women (n = 6) after normal vaginal delivery at term. Placental explants (300 mg) were incubated in duplicate at 37 degrees C in the presenc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(94)90015-9
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:This study was carried out to determine the efficacy and safety of the vaginal approach to paravaginal repair of symptomatic paravaginal defect cystocele. METHODS:This study is an observational case series of 100 consecutive women, referred from December 1996 to August 2000, with symptomatic grade II to IV p...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.119073
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to examine the association in humans between maternal psychosocial stress exposure during pregnancy and measures of glucose-insulin metabolism in the adult offspring. STUDY DESIGN:Healthy young adults whose mothers experienced major stressful life events during their pregnancy ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.03.006
更新日期:2008-11-01 00:00:00
abstract::We report a case of uterine cancer and invasive cervical cancer, detected incidentally during the female-to-male sex reassignment surgery. The management of these patients is presented. Such individuals may not be receiving regular gynecologic care appropriate to their remaining genital organs; symptoms of malignant d...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.12.057
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN:Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70534-4
更新日期:1998-05-01 00:00:00
abstract::Recombinant human-activated protein C (rhAPC) has been suggested to treat sepsis. We present the case of a 19-year-old pregnant patient at the 18th week of gestation with septic shock syndrome that originated from urinary tract infection and was successfully treated with rhAPC. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.04.046
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:A select group of Escherichia coli strains known as uropathogenic cause pyelonephritis in nonpregnant individuals. We investigated whether Escherichia coli from gestational pyelonephritis represent a random population or possess common uropathogenic characteristics. STUDY DESIGN:Repetitive element sequence-b...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70337-x
更新日期:1996-03-01 00:00:00
abstract::Among 1,613 women studied with routine ultrasonography prior to genetic amniocentesis at Northwestern University Medical School, 25 of 26 multiple gestations were detected. Sampling of fluid from both amniotic sacs was requested by 20 women with twin gestations in which both fetuses were ultrasonographically determine...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90029-0
更新日期:1980-09-15 00:00:00
abstract::A review of 80 cases of planned or anticipated cesarean hysterectomies done at major centers in the greater Los Angeles area is presented. There were no deaths and five cases of morbidity. Nineteen percent, or one of five cases, required blood transfusions. According to the recommendation of the American Association o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90287-4
更新日期:1984-05-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the normal beta-human chorionic gonadotropin change within 24 hours after a medical abortion. Because a medical abortion creates a "miscarriage," these data can represent the serum beta-human chorionic gonadotropin changes that would occur with a complete spontaneous...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(96)70463-5
更新日期:1996-02-01 00:00:00
abstract:OBJECTIVE:Placenta growth factor is a potent angiogenic factor produced by the human placenta that has been implicated in the pathogenesis of preeclampsia and intrauterine growth restriction. Placenta growth factor belongs to the vascular endothelial growth factor family and is capable of inducing proliferation, migrat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.107437
更新日期:2000-06-01 00:00:00
abstract::The ultrafast echo-planar magnetic resonance imaging technology, developed and built in Nottingham, has been used to produce the first snapshot images of the human fetus in utero. The imager, operating at a proton resonance frequency of 22 MHz, produces transaxial views in 64 or 128 milliseconds. These images comprise...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91209-u
更新日期:1990-08-01 00:00:00
abstract::Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in our departments. The incidence of alcohol abuse (greater than 60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social drinkers and the control...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91695-7
更新日期:1992-02-01 00:00:00
abstract:OBJECTIVE:Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preter...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.07.033
更新日期:2015-11-01 00:00:00
abstract::Because of the potential of dihydropyridine calcium channel blockers in the management of premature labor, we have studied the direct effects of nitrendipine on actomyosin in the pregnant and nonpregnant uterus and in the term human placenta. Actomyosin adenosinetriphosphatase in the three tissues and another model of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90679-4
更新日期:1986-02-01 00:00:00
abstract::Reanalysis of data on the ovulation method of natural family planning collected by the World Health Organization yields the following conclusions. The method is effective during perfect (correct and consistent) use, with a first-year probability of failure of 3.4%. However, it is extremely unforgiving of imperfect use...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)90581-x
更新日期:1991-12-01 00:00:00
abstract:OBJECTIVE:Our purpose was to demonstrate the clinical efficacy and effect of hormone replacement therapy in menopause on quality of life. STUDY DESIGN:A randomized, open, 6-month comparison of hormone replacement therapy (estradiol transdermal system [Estraderm TTS] plus chlormadinone) and symptomatic treatment (verap...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-9378(94)70239-x
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVE:This study reports the gynecologic conditions in postmenopausal women (intact uterus on enrollment) in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study of tamoxifen and raloxifene (STAR)/P-2 trial. STUDY DESIGN:This study, with a median follow-up period of 81 months, evaluated the incide...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2011.06.067
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate the effect of methadone on fetal neurobehavioral functions and maternal physiologic indicators. STUDY DESIGN:Forty women attending a substance abuse treatment facility with otherwise uncomplicated pregnancies were evaluated at peak and trough methadone levels. Fet...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.02.075
更新日期:2005-09-01 00:00:00
abstract::Surgical experience with carcinomas of the uterus and rectum has provided new insights into the surgical anatomy of a lamina, which separates the paravesical space from the pararectal space. It has been proved that each of the lamina consists of the cardinal and lateral ligaments and pelvic splanchnic nerves, descendi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90614-w
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.06.014
更新日期:2018-11-01 00:00:00
abstract::Although anovulation associated with hyperprolactinemia is not an uncommon cause of infertility, the precise mechanism of the pathogenic process that induces hyperactivity (hypertrophy with hyperplasia) of pituitary lactotropes is unknown. We have recently experienced a case of anovulation and hyperprolactinemia in a ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80160-6
更新日期:1987-08-01 00:00:00
abstract::To test the hypothesis that amniotic fluid directly affects cardiac function, isolated rat hearts were perfused with varying concentrations of centrifuged and filtered human amniotic fluid. The most consistent change seen was a dose-dependent decrease in coronary flow rate. With 10% concentrations, a wide spectrum of ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90812-5
更新日期:1988-01-01 00:00:00
abstract::Plasma levels of estrogen were measured daily by radioimmunoassay for 28 consecutive days in 12 healthy euthyroid women and 15 thyrotoxic women (10 with hypomenorrhea and 5 with amenorrhea) before commencement of therapy (except in one case) in an effort to increase understanding of the relationship between the thyroi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90732-2
更新日期:1975-08-01 00:00:00