A comparison of vertical and pfannensteil incisions in patients undergoing cesarean delivery with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP)

Abstract

UNDERGOING CESAREAN DELIVERY WITH THE SYNDROME OF HEMOLYSIS, ELEVATED LIVER ENZYMES, AND LOW PLATELETS (HELLP) D. MICHAEL ARMSTRONG, EUGENE CHANG, CHRISTOPHER ROBINSON, SCOTT SULLIVAN, DONNA JOHNSON, STEPHEN VERMILLION, J. VAN DORSTEN, Medical University of South Carolina, Obstetrics and Gynecology, Charleston, South Carolina OBJECTIVE: To determine whether the use of a drain or midline incision resulted in a lower wound hematoma rate in patients with HELLP syndrome undergoing cesarean delivery. STUDY DESIGN: A retrospective chart review of patients diagnosed with HELLP syndrome that underwent Cesarean delivery at the Medical University of South Carolina from 1990-2002 was conducted. Medical records for these patients were examined for the type of incision and for the use of drains. Wound hematomas were analyzed with respect to the type of skin incision and whether or not a drain was used. Data were analyzed by the Fisher exact test. Significance was considered P ! .05. RESULTS: A total of 135 patients with HELLP syndrome undergoing cesarean section were identified. There were 107 patients with Pfannensteil incision and 28 patients with a vertical midline incision. Sixty patients had a drain placed intraoperatively and 75 patients who had no drain. Complication rates are listed in the chart below. CONCLUSION: In women with HELLP syndrome, the incidence of wound hematomas is not influenced by the type of skin incision or drain placement.