Usefulness of delayed primary closure in unplanned caesarean section to reduce surgical site infection in a resource-poor high population country: a randomised controlled trial

Objective: Surgical site infection (SSI) is a common complication, especially following emergency caesarean section (CS) leading to maternal morbidity and prolonged hospital stay. Results are conflicting regarding the ideal method of skin closure after abdominal surgery in clean contaminated and contaminated wound. To compare the outcome of wound health between primary and delayed primary closure (DPC) of skin incision in emergency CS. Material and Methods: A total of 70 pregnant women undergoing emergency caesarean deliveries with a history of membrane rupture were randomized into group A (n=40) and group B (n=30). In group A monofilament sutures were placed in skin incision but the wound was left open for daily dressing with normal saline. It was closed by tying the monofilament sutures on fifth day and stitches were removed on seventh day. In group B skin was apposed by a routine primary closure procedure. Results: No patient in group A required secondary wound closure following SSI (p<0.001) and duration of hospital stay was also significantly reduced (p<0.05). Conclusion: This trial demonstrated that DPC is effective in reduction of requirement of secondary stitches due to SSI in emergency CS.