Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Kominiarek and Espinal).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Kominiarek and Espinal).
Am J Obstet Gynecol MFM. 2024 May;6(5):101354. doi: 10.1016/j.ajogmf.2024.101354. Epub 2024 Mar 15.
This study aimed to identify evidence-based peripartum interventions for people with a body mass index ≥40 kg/m.
PubMed, MEDLINE, EMBASE, Cochrane, CINAHL, and ClinicalTrials.gov were searched from inception to 2022 without date, publication type, or language restrictions.
Cohort and randomized controlled trials that implemented an intervention and evaluated peripartum outcomes of people with a body mass index ≥40 kg/m were included. The primary outcome depended on the intervention but was commonly related to wound morbidity after cesarean delivery (ie, infection, separation, hematoma).
Meta-analysis was completed for interventions with at least 2 studies. Pooled risk ratios with 95% confidence intervals and heterogeneity (I statistics) were reported.
Of 20,301 studies screened, 30 studies (17 cohort and 13 randomized controlled trials) encompassing 10 types of interventions were included. The interventions included delivery planning (induction of labor, planned cesarean delivery), antibiotics during labor induction or for surgical prophylaxis, 6 types of cesarean delivery techniques, and anticoagulation dosing after a cesarean delivery. Planned cesarean delivery compared with planned vaginal delivery did not improve outcomes according to 3 cohort studies. One cohort study compared 3 g with 2 g of cephazolin prophylaxis for cesarean delivery and found no differences in surgical site infections. According to 3 cohort studies and 2 randomized controlled trials, there was no improvement in outcomes with a non-low transverse skin incision. Ten studies (4 cohort and 6 randomized controlled trials) met the inclusion criteria for the meta-analysis. Two randomized controlled trials compared subcuticular closure with suture vs staples after cesarean delivery and found no differences in wound morbidity within 6 weeks of cesarean delivery (n=422; risk ratio, 1.09; 95% confidence interval, 0.75-1.59; I=9%). Prophylactic negative-pressure wound therapy was compared with standard dressing in 4 cohort and 4 randomized controlled trials, which found no differences in wound morbidity (cohort n=2200; risk ratio, 1.19; 95% confidence interval, 0.88-1.63; I=66.1%) or surgical site infections (randomized controlled trial n=1262; risk ratio, 0.90; 95% confidence interval, 0.63-1.29; I=0).
Few studies address interventions in people with a body mass index ≥40 kg/m, and most studies did not demonstrate a benefit. Either staples or suture are recommended for subcuticular closure, but available data do not support prophylactic negative-pressure wound therapy after cesarean delivery for people with a body mass index ≥40 kg/m.
本研究旨在确定针对体重指数≥40kg/m²的围产期干预措施的证据。
从建库至 2022 年，检索了 PubMed、MEDLINE、EMBASE、Cochrane、CINAHL 和 ClinicalTrials.gov，无时间、出版类型或语言限制。
纳入了实施干预措施并评估体重指数≥40kg/m²的人群围产期结局的队列研究和随机对照试验。主要结局取决于干预措施，但通常与剖宫产术后的伤口发病率（即感染、分离、血肿）有关。
对至少有 2 项研究的干预措施进行了荟萃分析。报告了汇总风险比及其 95%置信区间和异质性（I ²统计量）。
在筛选出的 20301 项研究中，纳入了 30 项研究（17 项队列研究和 13 项随机对照试验），涵盖了 10 种干预措施。干预措施包括分娩计划（引产、计划剖宫产）、产程中或手术预防应用抗生素、6 种剖宫产技术以及剖宫产术后抗凝剂剂量。与计划阴道分娩相比，3 项队列研究表明计划剖宫产并不能改善结局。1 项队列研究比较了剖宫产术预防应用 3g 头孢唑林和 2g 头孢唑林，未发现手术部位感染的差异。根据 3 项队列研究和 2 项随机对照试验，非低横切口并未改善结局。10 项研究（4 项队列研究和 6 项随机对照试验）符合荟萃分析的纳入标准。2 项随机对照试验比较了剖宫产术后皮内缝合与缝合钉的切口闭合方式，发现在剖宫产术后 6 周内伤口发病率无差异（n=422；风险比，1.09；95%置信区间，0.75-1.59；I²=9%）。4 项队列研究和 4 项随机对照试验比较了预防性负压伤口治疗与标准敷料，未发现伤口发病率（队列 n=2200；风险比，1.19；95%置信区间，0.88-1.63；I²=66.1%）或手术部位感染（随机对照试验 n=1262；风险比，0.90；95%置信区间，0.63-1.29；I²=0）的差异。
很少有研究针对体重指数≥40kg/m²的人群的干预措施，且大多数研究并未显示出获益。皮内缝合时建议使用缝合钉或缝线，但现有数据不支持对体重指数≥40kg/m²的人群在剖宫产术后预防性应用负压伤口治疗。
