Wound Complications Followingcesarean Delivery of Patients with Hellp Syndrome: Pfannenstiel Versus Vertical Skin Incision

Abstract

Objective: We sought to determine whether vertical or Pfannenstiel skin incision was associated with fewer hemorrhagic and postoperative wound complications following cesarean delivery in patients with HELLP syndrome.Methods: As part of an extensive retrospective analysis of medical records for all patients with HELLP syndrome who delivered between January 1,1980 and June 30,1993, we investigated those delivering abdominally either using a midline or Pfannenstiel skin incision and primary skin closure.Main Outcome Measure: The principal outcome measure was wound complication as hematoma or dehiscence.Results: A total of 215 patients were identified; 185 patients received midline vertical skin incisions and 30 had Pfannenstiel incisions. In the midline group, there were 17 wound separations (17/185, 9%) and 5 other types of wound complication (total 22/185, 12%). Significantly more wound complications, as wound separation, occurred in 8 of the 30 (27%) patients with Pfannenstiel incisions (p = 0.01). The only fascia1 dehiscence in the entire series occurred in a patient with Pfannenstiel entry.Conclusion: In this patient series, cesarean delivery in patients with HELLP syndrome was associated with a doubling of postoperative wound complications when the abdomen was opened by Pfannenstiel rather than midline incision.