title: Cesarean section in morbidly obese women: supra or subumbilical transverse incision?
abstract: The obstetrician is more and more frequently faced with the decision to perform a cesarean section in obese women. We describe a technique of supra or subumbilical transverse cesarean section (depending on the height of the projection of the upper edge of the pubic symphysis) specifically designed for morbidly obese women with a voluminous panniculus. We evaluated feasibility and associated morbidity in a retrospective descriptive series of 18 patients operated between 2003 and 2008. We assessed the quality of access to the lower uterine segment and facility to extract the fetus. The mean body mass index was 47.7 kg/m(2) (range 40.1-60.8). The incision was subumbilical in 13 women (72.2%) and supraumbilical in 27.7%. With this technique, the exposition, the section of the lower uterine segment, and extraction of the baby are simple. It can be easily generalized and quickly learnt.
authors.affiliation: Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 boulevard Marechalde Lattre de Tassigny, Dijon cedex, France. herve_tixier@yahoo.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Tixier
authors.forename: Ségolène
authors.initials: S
authors.lastname: Thouvenot
authors.forename: Laurène
authors.initials: L
authors.lastname: Coulange
authors.forename: Caroline
authors.initials: C
authors.lastname: Peyronel
authors.forename: Laurence
authors.initials: L
authors.lastname: Filipuzzi
authors.forename: Paul
authors.initials: P
authors.lastname: Sagot
authors.forename: Serge
authors.initials: S
authors.lastname: Douvier
mesh_terms: D050153:Abdominal Fat; D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology / Q000601:surgery*; D011631:Pubic Symphysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus; D055815:Young Adult