Use of wound drains after caesarean section

Gates S, Anderson ER

Published Online:

September 8, 2010

Women who have a caesarean section operation (removing the baby by surgery through the mother's abdomen) sometimes have a wound drain put in place. The review did not find any differences in the risk of wound infection or other post operative complications between women who had wound drains compared with those who did not, but the evidence is not conclusive.

Abstract (click to read)

Background:

Subcutaneous and sub rectus sheath wound drains are sometimes used in women who have undergone caesarean section. The indications for using drains vary by clinician.

Objectives:

To compare the effects of using a wound drain with not using a wound drain at caesarean section, and of different types of drain, on maternal health and healthcare resource use.

Search strategy:

For this update we searched the Cochrane Wounds Group Specialised Register (searched 3/8/10); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 3); Ovid MEDLINE - 1950 to July Week 3 2010; Ovid MEDLINE - In-Process & Other Non-Indexed Citations August 02, 2010; Ovid EMBASE - 1980 to 2010 Week 30; EBSCO CINAHL - 1982 to July 30 2010.

Selection criteria:

Studies were included if they allocated women to groups at random and they compared any type of wound drain with no wound drainage, or with any other type of drain, in women undergoing caesarean section.

Data collection and analysis:

Trials were evaluated for appropriateness for inclusion and methodological quality without consideration of their results. This was done by two reviewers according to pre-stated eligibility criteria.

Main results:

Nine trials (2421 women) were included in the review. Meta-analysis found no evidence of a difference in the risk of wound infection, other wound complications, febrile morbidity or endometritis in women who had wound drains compared with those who did not. There was some evidence from one trial that a subcutaneous drain may increase wound infection compared to a sub-sheath drain (RR 5.42, 95% CI 1.28 to 22.98). No differences in outcomes were found between subcutaneous drainage and subcutaneous suturing in the three trials that made this comparison.

Authors' conclusions:

At present there is no evidence that the routine use of wound drains at caesarean section confers any benefit to the women involved. However, neither moderate benefit nor harm are excluded. These trials do not answer the question of whether wound drainage is of benefit when haemostasis is not felt to be adequate. Further large trials comparing drainage with no drain are justified.

This record should be cited as:

Gates S, Anderson ER. Wound drainage for caesarean section. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004549. DOI: 10.1002/14651858.CD004549.pub2

Assessed as up to date:

August 3, 2010

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Primary Review Group:

Health topics:

Pregnancy & childbirth > Caesarian section > Surgical techniques

Wounds > Surgical wounds > Drainage systems

Wounds > Wounds > Drainage systems

Wounds > Acute wounds

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Use of wound drains after caesarean section

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