CC BY-NC-ND 4.0 · Am J Perinatol
DOI: 10.1055/s-0043-1775562
Review Article

A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions

Theodore Goldman
1   Obstetrics and Gynecology, Northwell Health, Huntington, New York
Ben Costa
2   Global Clinical and Medical Affairs, Smith + Nephew, Hull, United Kingdom
› Author Affiliations
Funding This study was funded by Smith & Nephew, Inc.


This paper aims to evaluate whether there is a device-dependent effect on the reduction of surgical site complications in obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing cesarean section (C-section). PubMed, Embase, Cochrane Library, and were searched for the period, January 2011 to September 2021. English language articles describing a randomized controlled trial (RCT) that compared either a −80 or −125 mm Hg single-use negative pressure wound therapy (sNPWT) device to standard dressings in obese (BMI ≥ 30 kg/m2) patients undergoing C-section were included. Conference abstracts and “terminated” RCTs with published results were deemed eligible for inclusion. The primary outcome of interest was surgical site infection (SSI), classified as composite, superficial, or deep. Secondary outcomes assessed included seroma, dehiscence, hematoma, bleeding, reoperation, readmission, blistering, and (composite) wound complications. A total of 223 titles were identified, of which 129 were screened by full-text review. Eleven RCTs encompassing 5,847 patients met the inclusion criteria and were considered eligible for further analysis (−80 mm Hg: six studies; −125 mm Hg: five studies). A statistically significant improvement in the composite SSI (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54–0.89) and superficial SSI (OR: 0.66; 95% CI: 0.50–0.86) outcomes was observed with the −80 mm Hg device, compared with standard dressings. The same effect on SSI outcomes was not observed with the −125 mm Hg device (composite SSI—OR: 0.91; 95% CI: 0.64–1.28; superficial SSI—OR: 1.12; 95% CI: 0.70–1.78). There were no statistically significant differences in any of the other assessed outcomes. sNPWT devices may differ in their ability to reduce composite or superficial SSI after C-section.

Key Points

  • Negative pressure benefits obese patients undergoing C-section.

  • Negative pressure devices may differ in performance.

  • A head-to-head clinical trial is needed.

Supplementary Material

Publication History

Received: 21 September 2022

Accepted: 17 August 2023

Article published online:
19 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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