511 Choosing the optimal skin incision for cesarean delivery in patients with morbid obesity

Abstract

Although there have been studies comparing Pfannenstiel incision (PI) with supraumbilical vertical skin incision (SVI) in obese women, the optimal skin incision for cesarean delivery (CD) in patients with class III obesity has not been determined. Our objective was to evaluate if PI vs SVI had any significant differences in maternal or neonatal outcomes in women with body mass index (BMI) ≥50 undergoing CD. We conducted a retrospective cohort study in pregnant women with BMI ≥50 undergoing CD at a single tertiary care center from 2016 to 2020. Electronic medical records and operative reports were used to collect study variables and identify the study groups: PI vs SVI. SVI incisions were performed on patients with hanging pannus (umbilicus at the level of the pubic bone) following evaluation by a multi-disciplinary team. Primary outcome was surgical blood loss. Secondary outcomes were hysterotomy type, surgical time, negative pressure wound therapy use, neonatal outcomes, and surgical complications. Mann-Whitney U test and chi-squared test were used to compare continuous and categorical data, respectively. During our study period, 70 women with BMI ≥50 were delivered by CD. Of those, 40 (57%) women had PI, and 30 (43%) women had SVI. Surgical blood loss was significantly lower in the PI group compared to the SVI group (832ml vs. 1000ml, p=0.024); however, there was no difference in postpartum hemorrhage rates. Patients with SVI were more likely to undergo classical hysterotomy and had significantly longer operating times (Table). There was no significant difference in either immediate or delayed post-operative complications (Table), nor in neonatal outcomes between the two groups. Although morbidly obese patients undergoing CD via SVI had significantly increased surgical blood loss, this difference was not clinically significant. In morbidly obese women with a hanging pannus, performing a SVI is safe in terms of immediate and delayed surgical complications when compared with PI, despite a longer surgical time and an increased rate of classical hysterotomy.