The Effect of Cesarean Delivery Skin Incision Approach in Morbidly Obese Women on the Rate of Classical Hysterotomy. (20th November 2013)

• Record Type: Journal Article
• Authors: Brocato, Brian E.; Thorpe, Edwin M.; Gomez, Luis M.; Wan, Jim Y.; Mari, Giancarlo
• Other Names: Ness Roberta B. Academic Editor.
• Is Part Of: Journal of pregnancy. Volume 2013(2013)
• Publication Date: 2013-11-20
• Subjects: Pregnancy -- Periodicals; Pregnancy -- Complications -- Periodicals; Pregnancy; Pregnancy Complications; Pregnancy; Pregnancy -- Complications; Electronic journals; Periodicals; Periodicals; 618.2
• DOI: 10.1155/2013/890296
• Languages: English
• ISSNs: 2090-2727

Abstract

Abstract : Objective . To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI) greater than 40 kg/m 2 who underwent a supraumbilical incision at the time of cesarean delivery. Methods . We conducted a retrospective cohort study in women having a BMI greater than 40 kg/m 2 who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, n = 45 ) or Pfannenstiel (controls, n = 90 ) skin incisions. Results . Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.0–66.8), surgical drain placement (OR, 6.5; 95% CI, 2.6–16.2), estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.4–8.4), and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; P < .001 ) when compared to subjects with Pfannenstiel incisions (controls). There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.9–8.0). Conclusion . In women with a BMI above 40 kg/m 2, supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.