984: A comparison of fascial suture types on post-cesarean infectious morbidity

Abstract

between Pitocin, double lumen cervical ripening balloon (CRB) and prostaglandins (PGs). Since mechanical manipulation might affect the cervix, we aimed to investigate differences in cervical recuperation following different methods of induction and other cervical manipulations. STUDY DESIGN: The study was conducted between june 2016 to june 2018. Following informed consent, cervical length (CL) measurements were performed trans-vaginally following spontaneous and induced vaginal deliveries. All measurements were performed by a single observer (R.L) at 8, 24 and 48 hours postpartum. CL at the second trimester, demographic characteristics, obstetric history, parity, delivery outcomes, previous cervical manipulations and induction mode, were obtained from the patient's' medical records. RESULTS: Our cohort included 498 women. The average CL, 48 hours postpartum, following spontaneous term deliveries (254 women) was 35.2AE3.5 mm. 79 patients were induced with Dinoprostone, 77 with Pitocin and 88 by CRB. Significant abnormal cervical recovery was demonstrated in the CRB group compared to the Pitocin and the PGs groups (26.3AE1.9 mm vs. 35.9AE2.3 mm vs. 34.4AE3.1 mm, respectively (P¼0.012)) ( Fig 1a). One hundred twenty six patients had history of D&Cs, 49 had one D&C, 35 had two D&Cs and 43 patients had more than 2 D&Cs. Patients with more than 2 D&Cs demonstrated abnormal cervical recovery compared to patients that had 2 or 1 D&C (27.9AE2.3 mm vs. 32.6AE2.7 mm vs. 38.5AE1.8 mm, respectively (P¼0.028)) (Fig 1b). CONCLUSION: Cervical manipulations such as mechanical inductions and repeated D&Cs may cause damage to the cervix and increase its`recovery time. This has only been proven for the double lumen cervical ripening balloon and has not been evaluated for a Foley catheter. Although the clinical significance of delayed cervical recuperation postpartum has not been elucidated yet, these results might imply future cervical insufficiency and possible risk of preterm birth. Our results raise the question whether mechanical modes of induction have a negative and possibly long-term effect on the cervix. OBJECTIVE:The objective of this study was to determine if polydioxanone suture compared to polyglactin suture reduced the incidence of wound and fascial complications after cesarean deliveries.ajog.org