title: The effect of cesarean delivery skin incision approach in morbidly obese women on the rate of classical hysterotomy.
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, n = 45) or Pfannenstiel (controls, n = 90) 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; P < .001) 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Brocato
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Thorpe
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Gomez
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Mari
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000706:statistics & numerical data*; D009767:Obesity, Morbid; D061646:Operative Time; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult