Cesarean Section Incision Complications and Associated Risk Factors: A Quality Assurance Project

Background: Today in the United States, approximately 30% of deliveries are performed by cesarean section. Wound infections and other post-operative complications represent a frequent morbidity which may be improved with an understanding of local risk factors. Objective: This project used a retrospective analysis of cesarean section incision complications and infection events along with patient chart information to identify potential risk factors associated with incisional wound complications at our institution. Methods: ICD9 codes identified 618 cesarean sections from July 2012 through June 2013. Of these, 59 were excluded. Twelve different data elements were examined and complications were divided into two categories: presence of infection and presence of seroma/hematoma. Statistics included univariate analysis and multiple logistic regressions to identify an odds ratio for associations using P < 0.05 as significant. Results: 73 (13.1%) of 559 patients developed a post-partum incision complication. Five logistic variables were included in amultiple logistic regression model for all incision complications. Three of the five variables had a significant odds ratio: emergent cesarean section, stapled skin closure, and preeclampsia. Five logistic variables were included in another multiple logistic regression model for all wound infections. Two of the five variables had a significant odds ratio: BMI > 33.4 and preeclampsia. Conclusions: Cesarean section rates account for approximately 30% of deliveries, with significant maternal morbidity associated with incisional wound complications. This study found multiple significant risk factors for both wound complications and infections. Preeclampsia was an independent risk factor for both wound complications and infections.

Cinobufotalin as a Novel Agent to Inhibit in Vitro Epithelial Ovarian Cancer Cell Proliferation, Migration and Invasion

Objective: Cinobufotalin (CINO), a cardiotonic steroid (CTS) or bufadienolide, is extracted from the skin secretions of giant toads and is utilized in traditional Chinese medicine (Chan Su). CINO has been used as a cardiotonic, diuretic and a hemostatic agent. Recently, CINO has been shown to inhibit lung cancer cell function and has been implicated in several other disease processes. In this study, we pursued the potential anticancer application of CINO using the ovarian tumor cell line SK-OV-3. Study Design: We evaluated the effect of CINO on cultures of SK-OV-3. Cells were treated with 0.1, 0.5, 1, 5, and 10 μM CINO. Cell proliferation, migration, invasion, and viability were measured using commercially available kits. Cell cycle progression was evaluated by a Cell Cycle Phase Determination Kit. Apoptosis was evaluated by an Apoptotic Blebs Assay Kit;cell cycle arrest and apoptotic signaling were determined by fluorescence-activated cell sorting (FACS) analysis. Results: CINO at ≥ 0.5 μM inhibited SKOV-3 cell proliferation, migration, and invasion (p < 0.05). There was a higher (p < 0.05) percentage of S phase cells in groups treated with CINO at 0.5 μM. CINO at ≥ 0.5 μM down regulated expression of Proliferating Cell Nuclear Antigen (PCNA) and caused cell death. Conclusion: This data demonstrates that CINO impairs SK-OV-3 cell function via cell cycle arrest and apoptotic signaling, suggesting CINO be further investigated as a novel anti-ovarian cancer agent.