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Journal of Pregnancy
Volume 2013 (2013), Article ID 890296, 3 pages
http://dx.doi.org/10.1155/2013/890296
Research Article

The Effect of Cesarean Delivery Skin Incision Approach in Morbidly Obese Women on the Rate of Classical Hysterotomy

1Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA
2Department of Preventive Medicine, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA

Received 15 August 2013; Accepted 22 October 2013

Academic Editor: Roberta B. Ness

Copyright © 2013 Brian E. Brocato et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI) greater than 40 kg/m2 who underwent a supraumbilical incision at the time of cesarean delivery. Methods. We conducted a retrospective cohort study in women having a BMI greater than 40 kg/m2 who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, ) or Pfannenstiel (controls, ) skin incisions. Results. Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.0–66.8), surgical drain placement (OR, 6.5; 95% CI, 2.6–16.2), estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.4–8.4), and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; ) when compared to subjects with Pfannenstiel incisions (controls). There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.9–8.0). Conclusion. In women with a BMI above 40 kg/m2, supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.