Importance Surgical site infection (SSI) is a common complication of cesarean delivery. Seen in up to 12% of cesarean deliveries, it is a major cause of prolonged hospital stay and a burden to the healthcare system. Interventions and techniques must be identified to decrease the risk of cesarean delivery SSIs. Objective We review the categories of SSI, current studies that have focused on various interventions to decrease SSI, and preoperative, intraoperative, and postoperative recommendations for cesarean delivery SSI prevention. Evidence Acquisition A thorough search of PubMed for all current literature was performed. Various surgical interventions and techniques were reviewed. We included studies that looked at preoperative, intraoperative, and postoperative interventions for SSI prevention. Results We have summarized several surgical interventions and techniques as well as current consensus statements to aid the practitioner in preventing SSIs after cesarean delivery. Conclusions and Relevance Upon analysis of current data and consensus statements pertaining to cesarean deliveries, there are certain preoperative, intraoperative, and postoperative interventions and techniques that can be recommended to decrease the risk of cesarean delivery SSI. Target Audience Obstetricians and gynecologists; family physicians Learning Objectives After completing this CME activity, physicians should be better able to evaluate preoperative considerations when preparing for a cesarean delivery; distinguish the recommended antiseptic choices for preoperative cleansing/prepping before cesarean delivery; propose the appropriate use of prophylactic antibiotics for prevention of cesarean delivery SSI; and select the surgical techniques that have been shown to decrease the risk of cesarean delivery SSI.

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OBJECTIVE: Primary objective was to evaluate differences in twin birth weights (BW) between black and white parturients. Secondary objective was to determine the correlates of any observed disparity. STUDY DESIGN: We performed a retrospective cohort study of all dichorionic/diamniotic (DC) and monochorionic/diamniotic (MC) twin gestations delivered at a single academic center between 2000-2010 to black or white parturients greater than 23 weeks' gestation. We excluded fetal anomalies, aneuploidy, IUFD, or twin-to-twin transfusion syndrome. Average twin pair BW was compared and individual twins were assigned a BW percentile using published chorionicity-specific twin references. Average BW, percentile frequencies, maternal and obstetric variables were analyzed by univariate and regression analysis to determine clinical correlates of observed growth disparities. RESULTS: 530 twin sets were identified (267 white DC, 160 black DC, 65 white MC, and 38 black MC). The average BW of white DC twins was 2137g vs. 1956g for black DC twins (95% CI 265.2 to 94.8, p<0.001). The average BW of white MC twins was 2042g vs. 1758g for black MC twins (95% CI 478.7 to 89.7, p¼0.004). The distribution of BW percentiles was shifted significantly to the left (Figure) for black twins, including a greater frequency of BW <10th percentile (p¼0.002). No significant differences were identified in gestational age at delivery. Black parturients were significantly more likely to be younger, Medicaid recipients, single, and achieved less than the recommended weight gain; while white parturients were significantly more likely to have used assisted reproduction, smoke, and be diagnosed as pre-eclamptic. Regression analysis demonstrated that maternal race (p¼0.001) and pre-eclampsia (p¼0.04) were significantly associated with birth weight disparity (Table). CONCLUSION: Maternal race is an independent determinant of BW in both DC and MC twins. The shifted distribution of BW percentiles between black and white DC and MC twins suggests the need for race/ethnicity-specific growth standards for twins, as have been recently developed for singletons.