A randomised trial of caesarean wound coverage: Exposed compared to dressed.

To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic Caesarean wound is left exposed compared to dressed after skin closure DESIGN: Randomised trial SETTING: University Hospital, Malaysia: April 2016-October 2016 POPULATION: 331 women delivered by Caesarean section METHOD: Participants were randomised to leaving their wound entirely exposed (n=165) or dressed (n=166) with a low adhesive dressing (next day removal) MAIN OUTCOME MEASURES: Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on Day 14 and 28) and patient satisfaction with wound coverage management before hospital discharge RESULTS: The superficial SSI rates were 2/153(1.3%) versus 5/157(3.2%) RR 0.4 95%CI 0.1-2.1; P=0.45 and patient satisfaction with wound management were 7[5-8] vs. 7[5-8]; P=0.81 in exposed compared with dressed arms respectively. In the wound-exposed arm, stated preference for wound exposure significantly increased from 35.5% to 57.5% whereas in the wound-dressed arm, the stated preference for a dressed wound fell from 48.5% to 34.4% when assessed at recruitment (pre-randomisation) to at Day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to Day 28 across trial arms.The trial is underpowered as SSI rates were lower than expected. Nevertheless, caesarean wounds left exposed appears not to carry detrimental effects, provided patient counseling to manage expectations is undertaken.

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