Low Versus High Transverse Skin Incisions for Obese Patients Undergoing Cesarean Delivery [14K

Abstract

INTRODUCTION: Surgical outcomes of obese patients receiving high (infraumbilical) versus low (Pfannensteil) transverse skin incisions at the time of Cesarean delivery (CD) were compared. While Pfannensteil and vertical skin incisions have been compared in the literature, few studies have examined outcomes of high versus low transverse incisions in the obese population. METHODS: A retrospective cohort of 274 obese women underwent CD by either low or high transverse skin incision. Demographics in addition to surgical and postoperative outcomes were collected. The primary outcome was wound complications. Additional outcomes included blood loss and operative time. Chi-square, Fischer's Exact test and Mann-Whitney U tests were used for statistical analysis. RESULTS: Women in the high incision group had a significantly larger BMI (51 versus 45) and a trend of increased gestational diabetes (32.5% versus 19.2%). There was no difference in other baseline demographics. The high incision group had a significantly increased estimated blood loss compared to the low incision group (800 versus 700 mL). There was no difference in the primary outcome of wound complications. These findings remained when only analyzing the class III obesity group. CONCLUSION: Although Pfannensteil incisions were most commonly chosen, providers were more likely to select a high transverse skin incision in patients with increasing BMIs. While blood loss was found to be increased with high transverse incisions, no difference was noted in wound complications despite the higher median BMI in this group. Further prospective trials are needed to study the effects of high versus low transverse skin incisions in the obese population.