title: Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery.
abstract: OBJECTIVE
  To determine factors influencing separation and infectious type wound complications (WCs) in morbidly obese women undergoing primary cesarean delivery (CD).
  
  
  METHODS
  Retrospective cohort study evaluating infectious and separation WC in morbidly obese (body mass index [BMI] > 35 kg/m(2)) women undergoing primary CD between January 1994 and December 2008. Chi-square, Fisher's exact and Student's t tests used to assess associated factors; backward logistic regression to determine unadjusted and adjusted odds ratios.
  
  
  RESULTS
  Of 623 women, low transverse skin incisions were performed in 588 (94.4%), vertical in 35 (7%). Overall WC rate was 13.5%, which varied by incision type (vertical 45.7% vs. 11.6% transverse; p < 0.01), but not BMI class. Incision type and unscheduled CD were associated with infection risk, while incision type, BMI, race and drain use were associated with wound separation.
  
  
  CONCLUSIONS
  In morbidly obese women both infectious and separation type WC are more common in vertical than low transverse incisions; therefore transverse should be preferred.
authors.affiliation: Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY 14642, USA. Loralei_thornburg@urmc.rochester.edu
authors.forename: Loralei L
authors.initials: LL
authors.lastname: Thornburg
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Linder
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Durie
authors.forename: Brittany
authors.initials: B
authors.lastname: Walker
authors.forename: Eva K
authors.initials: EK
authors.lastname: Pressman
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Glantz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000534:rehabilitation / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult