Cesarean Section; Infection, Negative Pressure Wound Therapy
Conditions
Brief summary
To assess patient centered outcomes of the Medela INVIA Motion prophylactic NPWT system at cesarean delivery.
Detailed description
This study will be a two center case series of women undergoing caesarean delivery conducted at two medical centers in Indianapolis, Indiana. All patients meeting inclusion criteria will be included. All enrolled patients will receive the Medela INVIA Motion prophylactic NPWT device. Visit A: Interventional Procedure All enrolled patients will receive the Medela INVIA Motion device placed by the patient's surgeon after the skin is closed with subcuticular suture or staples. Research staff and clinicians (labor & delivery and postpartum nurses, OR technicians, physicians, etc.) involved in the study will receive formal training on how to place and remove the prophylactic NPWT device. Visit B: Post Procedure until Discharge Patients will be monitored daily while in the hospital by clinical staff and/or research staff for complications. The negative pressure wound therapy dressing will be removed on the day of discharge. If the patient remains hospitalized for more than 7 days, the dressing will be removed on postoperative day 7. Replacement of any dressing that is saturated. If a patient develops infection with the NPWT device in place the device will be removed and the patient given standard SSI therapy as outlined below. Patients will be educated about the signs and symptoms of infection and other study outcomes and encouraged to call their provider if these should arise. Research staff document inpatient course regarding SSI. Management of surgical site infections will follow the Practice Guidelines of the Infectious Diseases Society of America. Visit C: Postpartum Follow Up We will use active surveillance by research staff to ascertain surgical site infections: Research staff will follow-up with the research participant at time of discharge or within 48 hours post discharge (postpartum day 1-9) to assess for adverse events, assess the participant's pain, obtain their satisfaction with their dressing and aesthetic appearance of the incision. Research staff will call subjects on approximately postoperative day 30 (±2 days). They will ask the patient standardized questions regarding wound complications, patient satisfaction, pain and aesthetic appearance. If the patient reports a hospital, clinic, or ER visit not associated with the study centers, the staff will obtain the name of the medical facility and request the records. The EQ-5D-3L quality of life questionnaire will be administered at the 30-day call. Medical records from postpartum clinic visits as well as records of unscheduled visits (to any hospital clinic or ER) will be sought to ascertain study outcomes. At the time of the subject's standard of care postpartum appointment about 4-6 weeks after inpatient hospital discharge research staff will collect information on outcomes, pain and patient satisfaction. If the patient does not attend the clinical postpartum visit, the study staff will contact the subject by phone to collect the data.
Interventions
Invia Motion NPWT system at cesarean delivery
Sponsors
Study design
Intervention model description
Medela Invia pump
Eligibility
Inclusion criteria
1. Scheduled/non-labor or unscheduled/labor cesarean delivery 2. Gestational age greater than or equal to 23 weeks
Exclusion criteria
1. Unwilling or unable to provide consent 2. Non-availability for postoperative follow-up 3. Contraindication to NPWT
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Scores: Discharge Time Frame | At post-operative day 3 (+/- 1 days) | Pain scores (pain score on scale of 0 - 10); 0 represents no pain, 10 represents highest pain |
| Pain Scores: Scores Postpartum Day 30 | At postoperative day 30 (+/- 2 days) | Pain scores (pain score on scale of 0 - 10); 0 represents no pain, 10 represents highest pain |
| Patient Satisfaction: Scores Discharge Time Frame | At postoperative day 3 (+/- 1 days) | Patient satisfaction scores (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction |
| Patient Satisfaction: Scores Postpartum Day 30 | At postoperative day 30 (+/- 2 days) | Patient satisfaction scores (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction |
| Patient Satisfaction With Aesthetic Appearance: Scale | At postoperative day 30 (+/- 2 days) | Patient satisfaction with aesthetic appearance (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Allergic Reaction; Safety Outcomes | 4-6 Weeks Postpartum | Safety outcome; proportion of allergic reaction to wound dressing |
| Wound Infection; Proportion of Incidence | 4-6 Weeks Postpartum | Composite wound complication; wound infection as diagnosed by treating clinician |
| Wound Bleeding; Safety Outcomes | 4-6 Weeks Postpartum | Safety outcome; proportion of wound bleeding |
| Wound Separation; Proportion of Incidence | 4-6 Weeks Postpartum | Composite wound complication; wound separation as diagnosed by treating clinician |
| Seroma; Proportion of Incidence | 4-6 Weeks Postpartum | Composite wound complication; seroma as diagnosed by treating clinician |
| Antibiotics Prescribed for Presumed SSI; Proportion of Incidence | 4-6 Weeks Postpartum | Composite wound complication; antibiotics prescribed by treating clinician for wound-related infection |
| Skin Blistering; Safety Outcomes | 4-6 Weeks Postpartum | Safety outcome; proportion of incidence of skin blistering around surgical wound |
Countries
United States
Participant flow
Pre-assignment details
All patient undergoing cesarean delivery who consented were included
Participants by arm
| Arm | Count |
|---|---|
| Invia Motion Arm Invia Motion: Invia Motion NPWT system at cesarean delivery | 20 |
| Total | 20 |
Baseline characteristics
| Characteristic | Invia Motion Arm |
|---|---|
| Age, Continuous | 25 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 19 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 6 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 14 Participants |
| Sex: Female, Male Female | 20 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 20 |
| other Total, other adverse events | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 |
Outcome results
Pain Scores: Discharge Time Frame
Pain scores (pain score on scale of 0 - 10); 0 represents no pain, 10 represents highest pain
Time frame: At post-operative day 3 (+/- 1 days)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Invia Motion Arm | Pain Scores: Discharge Time Frame | 2.5 score on a scale |
Pain Scores: Scores Postpartum Day 30
Pain scores (pain score on scale of 0 - 10); 0 represents no pain, 10 represents highest pain
Time frame: At postoperative day 30 (+/- 2 days)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Invia Motion Arm | Pain Scores: Scores Postpartum Day 30 | 0 score on a scale |
Patient Satisfaction: Scores Discharge Time Frame
Patient satisfaction scores (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction
Time frame: At postoperative day 3 (+/- 1 days)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Invia Motion Arm | Patient Satisfaction: Scores Discharge Time Frame | 10 score on a scale |
Patient Satisfaction: Scores Postpartum Day 30
Patient satisfaction scores (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction
Time frame: At postoperative day 30 (+/- 2 days)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Invia Motion Arm | Patient Satisfaction: Scores Postpartum Day 30 | 10 score on a scale |
Patient Satisfaction With Aesthetic Appearance: Scale
Patient satisfaction with aesthetic appearance (satisfaction score on scale of 0 - 10); 0 represents no satisfaction, 10 represents highest satisfaction
Time frame: At postoperative day 30 (+/- 2 days)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Invia Motion Arm | Patient Satisfaction With Aesthetic Appearance: Scale | 10 score on a scale |
Allergic Reaction; Safety Outcomes
Safety outcome; proportion of allergic reaction to wound dressing
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Allergic Reaction; Safety Outcomes | 0 Participants |
Antibiotics Prescribed for Presumed SSI; Proportion of Incidence
Composite wound complication; antibiotics prescribed by treating clinician for wound-related infection
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Antibiotics Prescribed for Presumed SSI; Proportion of Incidence | 0 Participants |
Seroma; Proportion of Incidence
Composite wound complication; seroma as diagnosed by treating clinician
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Seroma; Proportion of Incidence | 0 Participants |
Skin Blistering; Safety Outcomes
Safety outcome; proportion of incidence of skin blistering around surgical wound
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Skin Blistering; Safety Outcomes | 0 Participants |
Wound Bleeding; Safety Outcomes
Safety outcome; proportion of wound bleeding
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Wound Bleeding; Safety Outcomes | 0 Participants |
Wound Infection; Proportion of Incidence
Composite wound complication; wound infection as diagnosed by treating clinician
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Wound Infection; Proportion of Incidence | 0 Participants |
Wound Separation; Proportion of Incidence
Composite wound complication; wound separation as diagnosed by treating clinician
Time frame: 4-6 Weeks Postpartum
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Invia Motion Arm | Wound Separation; Proportion of Incidence | 0 Participants |