Incision choice for cesarean delivery in obese patients: experience in a university hospital

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 97; no. 4; pp. S62 - S63
• Main Authors: D’ Heureux-Jones, Anne Marie, Buhimschi, C.S., Anderson, E., Kopelman, J., Malinow, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2001; The American College of Obstetricians and Gynecologists
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(01)01295-9

Objective: Cesarean deliveries in obese patients are surgically difficult and associated with a higher incidence of complications. The choices of skin or uterine incision are subjective. Our aim was to determine the impact of different incisions on the speed of the operation and the intraoperative and postoperative morbidity in obese patients. Methods: We conducted a 14-month retrospective review of all primary singleton cesarean deliveries performed at our institution. The abdominal (vertical: V, or Pfannenstiel: P) and uterine incision (low transverse: L, or classical: C) were evaluated by one-way and two-way ANOVA for their impact on the time of delivery (skin–baby) based on maternal weight in obese (>200 lb) versus nonobese women. Measures of intraoperative and postoperative morbidity included EBL, wound infections, and metritis. Results: Seventy-one patients were subjects of this study. Forty-five patients (63%) met criteria for obesity (265.1 ± 8.4 lbs), significantly different from nonobese patients (156.5 ± 4.1 lbs). PL was the most frequent association both in the obese (64%, n = 29) and nonobese (88%, n = 23), with an average skin–baby time of 9.4 ± 0.8 minutes and 9.9 ± 1.1minutes, respectively ( P < 0.05). In both obese and nonobese patients, a C was associated with a higher rate of prematurity and NICU admission. When a C was performed, the time was longer if the patient was obese (16.4 ± 2.8 min) versus nonobese (9.07 + 1.2 min), P = 0.03). Skin incisions did not affect the speed of delivery. In obese patients, VL had the highest EBL (1,167 ± 3.57 cc) and PL the lowest (1,075 ± 5.1cc, P = 0.02), both increased compared with nonobese patients with similar incisions. Metritis, but not wound infection, was more frequent in obese patients (20%) versus nonobese patients (3%), irrespective of the incision type. Length of stay was not affected either by obesity or by incision type. Conclusions: The combination of P and L is preferred for cesarean delivery in both obese and nonobese patients. For obese patients, PL is further advantageous because it improves speed of operation, blood loss, and rate of complications.