Transverse Supraumbilical versus Pfannenstiel Incision for Cesarean Section in Morbidly Obese Women “A Randomized Controlled Trial”

Abstract

Abstract Background Cesarean section is one of the most common operative procedures performed in modern obstetrics, cesarean section is defined as the birth of a fetus through incision in the abdominal wall and the uterine wall. Obesity is currently the most prevalent health threat the world over and its influence on general health is rapidly increasing. Obesity has a dramatic impact on pregnancy outcome. Apart from an associated increased prevalence of diabetes and hypertension, obesity in pregnancy has been associated with poor perinatal and neonatal outcomes. Obese mothers have an increased risk of pregnancy complications such as anemia, hypertension, pre-eclampsia, preterm delivery, emergency cesarean section, and gestational diabetes and significantly increases the rate of cesarean section. Aim of the Work This study aimed to evaluate the efficacy and safety of transverse supraumbilical incision compared of pfannenstiel incision in morbidly obese women undergoing cesarean section. Patients and Methods This study was conducted in the casualties of Ain Shams University Maternity Hospital. Parallel, superiority randomized controlled trial with allocation ratios 1:1. All Participants 72 women will be randomly allocated into two groups; each group will be included 36 women, one group will be those who will undergo the transverse supraumbilical incision while other group will undergo pfannenstiel incision. Randomization will be performed in advance by computer using variable blocks the random number generator in MS Excel (Microsoft, Seattle, WA, USA). Results As regard risk analysis for the incidence of adverse outcomes TSU inicision is associated with significantly lower risk for wound complication compared with a pfannenstiel-type incision (RR = 0.19, 95% CI = 0.07 to 0.5, p-value=0.0008). The number needed to treat is 2.1 with a 95% CI ranging from 1.5 to 3.6. There is faster regain of intestinal motility in transverse supraumbilical incision compared with pfannenstiel incision. Mean post-operative hospital stay in transverse supraumbilical group was (2.4) hours while that of pfannenstiel group (2.9) hours with no significant difference. Conclusion The transverse supraumbilical incision showed definite advantages over pfannenstiel incision; being faster to preform, less blood loss, less post-operative pain, earlier regain of intestinal motility, earlier ambulation, shorter hospital stay. Another Aspect, being economic, saving more of the stuff’s time, utilizing less anesthesia and needing least instruments.