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Objective: The null hypothesis for this investigation was that there was no difference in the frequency ofwound disruption betweenwomenwhohad theirsubcutaneous tissues approximated with suture and those who did not during cesarean section. Methods: During alternating months, consecutivewomen delivered by cesarean section either did (N 716) or did not (N 693) have their subcutaneous tissues closed with suture. All data were analyzed using chi square, Student’s t-test, Fisher’s exact probability test, analysis of variance, or logistic regression. Results:A 32% decrease in the frequency ofwound disruption was observed when subcutaneous tissues were brought into apposition with suture at cesarean section (P 0.03). Conclusions: Closure of Scarpa’s and Camper’s fascia with suture during cesarean section significantly decreased the frequency ofwound disruption in this population. (C) 1994 Wiley-Liss, Inc.

The purpose of the present study was to evaluate the frequency of wound complications comparing staples to suture closure of the skin. During a 6-month period, all patients who underwent cesarean delivery were assigned to have their skin approximated with either subcuticular sutures or surgical staples. The remainder of the closure techniques were the same in each group. Risk factors for wound complications were identified and statistically analyzed. Twelve hundred and eighty-nine patients were evaluated. Of the 731 women with skin closure via staples, 66 (9%) had a superficial wound separation compared with only 13 (2.3%) of 558 when subcuticular suture was used to approximate the skin edges (P < 0.0001). This was significant only for vertical skin incisions. Thus, closure of the skin with subcuticular suture at the time of cesarean reduced the incidence of wound disruption by more than fourfold.

Objective: This study was undertaken to measure infant outcomes when pH at birth was compared with neonatal pH determined within 2 hours of age. Study Design: We retrospectively studied term infants born between January 1, 1988, and August 31, 1998, who had umbilical artery blood pH measured at birth and again from the radial artery or umbilical artery within 2 hours after birth. Statistical significance was determined with the χ2 test. Odds ratios and 95% confidence intervals were calculated by means of the Mantel-Haenszel method. Results: Data from a total of 1691 infants were analyzed: 178 (11%) had acidemia at birth (pH of

Umbilical cord blood acid-base analysis may be used to assess the condition of fetus and newborn more objectively. Newborn acid-base status is an important criterion when we attempt to define perinatal asphyxia. It also has medicolegal ramifications because it enables the documentation of the presence of a biochemical milieu that is not related to the later development of cerebral palsy. We anticipate future research will focus on the redefinition of acidemia and its relationship to fetal and new-born outcomes.

OBJECTIVE: We attempted to determine the frequency of postpartum perineal morbidity (dehiscence, infection, and rectovaginal fistula) in women after fourth-degree perineal repair. STUDY DESIGN: The medical records of 390 women at Parkland Memorial Hospital with fourth-degree perineal repair during 1989 and 1990 were retrospectively reviewed in a case-cohort study. Statistical analysis included χ 2 contingency tables, Fisher exact test, Mann-Whitney test, and analysis of variance. RESULTS: Twenty-one of 390 women (5.4%) had postpartum perineal morbidity. Seven (1.8%) had dehiscence alone, 11 (2.8%) had infection and dehiscence, and 3 (0.8%) had infection alone. Overall, there were 18 dehiscences (4.6%) and 14 infections (3.6%) in the total group with perineal morbidity. Two high rectovaginal fistulas were concomitantly detected in women with perineal dehiscence. Only shoulder dystocia, metritis, and postpartum fever occurred significantly more frequently in patients with postpartum perineal morbidity than in women without perineal morbidity. Smoking and human papillomavirus infection were not associated with perineal repair morbidity. CONCLUSIONS: Postpartum perineal morbidity after fourth-degree perineal repair is an uncommon event. It is not predicted by readily preventable antepartum or intrapartum factors.