Wound drainage for caesarean section.

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: This review draws on the search strategy developed for the Cochrane Wounds Group as a whole. Electronic databases (MEDLINE, EMBASE, Cinahl and CAB Health), and the reference lists of included articles were also searched up to June 2004

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: Seven trials (1993 women) were included in the review. Meta-analysis found no 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 that caesarean sections may be about five minutes shorter and that blood loss may be slightly lower when drains were not used.

AUTHORS' CONCLUSIONS: There is no evidence in the seven small trials included to suggest that the routine use of wound drains at caesarean section confers any benefit on the women involved. 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 are justified using blinded outcome assessment to examine the role of different types of wound drain at caesarean section. Comparing the use of drains in women with different degrees of obesity and in women having first or repeat caesareans and intrapartum or prelabour caesarean sections would be of interest. Women's views and experience of drains have not been studied in these trials.