Abdominal Incision Selection for Cesarean Delivery of Women with Class III Obesity

Abstract

Objective The objective of this study was to evaluate cesarean outcomes, stratified by abdominal incision type, in women with class III obesity.

Study Design We performed a retrospective cohort study of patients with class III obesity undergoing cesarean at our institution from 2010 to 2013 with singletons ≥ 34 weeks. Outcomes were compared between patients with transverse subpannicular and vertical abdominal incisions. The primary outcome was a wound composite (cellulitis, abscess, hematoma, seroma, or dehiscence). Other outcomes included transfusion, vertical hysterotomy, 5-minute Apgar < 7, and umbilical artery pH < 7.10.

Results Of 423 patients, 364 had subpannicular transverse, 57 had vertical, and 2 had periumbilical transverse incisions (not analyzed). Although vertical incisions were associated with more wound complications (26.3 vs. 14.8%; p = 0.03), the difference became null after adjustment (adjusted odds ratios [aOR], 1.7; 95% confidence interval [CI], 0.7, 4.1). Vertical incisions were associated with increased risk of vertical hysterotomy (aOR 4.8; 95% CI, 2.2, 10.4), decreased risk of 5-minute Apgar < 7 (aOR, 0.06; 95% CI, 0.004, 0.9), and not statistically significantly associated with transfusion (aOR, 4.2; 95% CI, 0.9, 19.0) or umbilical artery pH < 7.1 (aOR, 0.42; 95% CI, 0.11, 1.7).

Conclusions In women with class III obesity cesarean delivery via vertical abdominal incisions is associated with more maternal but less immediate neonatal complications.

Keywords

cesarean delivery - cesarean - obesity - morbid obesity - incision type

• References

• 1 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (8) 806-814
• 2 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121 (1) 213-217
• 3 Sebire NJ, Jolly M, Harris JP , et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25 (8) 1175-1182
• 4 Jensen DM, Damm P, Sørensen B , et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003; 189 (1) 239-244
• 5 Weiss JL, Malone FD, Emig D , et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004; 190 (4) 1091-1097
• 6 Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994; 170 (2) 560-565
• 7 Conner SN, Verticchio JC, Tuuli MG, Odibo AO, Macones GA, Cahill AG. Maternal obesity and risk of postcesarean wound complications. Am J Perinatol 2014; 31 (4) 299-304
• 8 Wall PD, Deucy EE, Glantz JC, Pressman EK. Vertical skin incisions and wound complications in the obese parturient. Obstet Gynecol 2003; 102 (5 Pt 1) 952-956
• 9 Bell J, Bell S, Vahratian A, Awonuga AO. Abdominal surgical incisions and perioperative morbidity among morbidly obese women undergoing cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2011; 154 (1) 16-19
• 10 Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203 (3) 271.e1-271.e7
• 11 Landon MB, Bergella V. Cesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM, Driscoll DA, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia: Churchill Livingston; 2012: 445-478
• 12 Thornburg LL, Linder MA, Durie DE, Walker B, Pressman EK, Glantz JC. Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery. J Matern Fetal Neonatal Med 2012; 25 (9) 1544-1548
• 13 Tixier H, Thouvenot S, Coulange L , et al. Cesarean section in morbidly obese women: supra or subumbilical transverse incision?. Acta Obstet Gynecol Scand 2009; 88 (9) 1049-1052
• 14 Marrs CC, Moussa HN, Sibai BM, Blackwell SC. The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity. Am J Obstet Gynecol 2014; 210 (4) 319.e1-319.e4
• 15 Chauhan SP, Magann EF, Wiggs CD, Barrilleaux PS, Martin Jr JN. Pregnancy after classic cesarean delivery. Obstet Gynecol 2002; 100 (5 Pt 1) 946-950
• 16 Edwards RK, Cantu J, Cliver S, Biggio Jr JR, Owen J, Tita AT. The association of maternal obesity with fetal pH and base deficit at cesarean delivery. Obstet Gynecol 2013; 122 (2 Pt 1) 262-267
• 17 Conner SN, Tuuli MG, Longman RE, Odibo AO, Macones GA, Cahill AG. Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery. Am J Obstet Gynecol 2013; 209 (4) 386.e1-386.e6