title: The utility of midtrimester ultrasound assessment of the subcutaneous space in predicting cesarean wound complications.
abstract: OBJECTIVE
  To evaluate the association between cesarean wound complications and thickness of the subcutaneous space within the anterior abdomen at the midtrimester fetal anatomical survey.
  
  
  METHODS
  In this case-control study, cases were identified using an ICD9 code for wound complications of cesarean delivery. For each case, we identified the woman with the next consecutive midtrimester ultrasound who had a cesarean delivery without a wound complication, matched on age and race, as the control. A blinded investigator measured subcutaneous space at three distinct suprapubic levels in the midsagital plane.
  
  
  RESULTS
  Of 7228 women with a cesarean delivery, 123 (1.7%) had a wound complication. Seventy-nine cases were eligible. Midline suprapubic subcutaneous thickness did not differ between cases and controls at the superior, middle or inferior locations (p ≥ 0.35). Body mass index was moderately correlated with ultrasound-derived measurements (r ≥ 0.63; p < 0.001). The incidence of vertical skin incision, stapled skin closure and classical hysterotomy differed between groups (p ≤ 0.046). There was no significant increase in wound complication risk with increasing subcutaneous space thickness, even after adjustment (p ≥ 0.34).
  
  
  CONCLUSIONS
  Prenatal ultrasound can quantify the subcutaneous space. Vertical skin incision, stapled wound closure, and a classical hysterotomy were associated with cesarean wound complication, but midtrimester subcutaneous thickness was not.
authors.affiliation: a Department of Obstetrics , Gynecology and Reproductive Biology, Harvard Medical School , Boston , MA , USA .
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shainker
authors.forename: Nandini
authors.initials: N
authors.lastname: Raghuraman
authors.forename: Anna M
authors.initials: AM
authors.lastname: Modest
authors.forename: William T
authors.initials: WT
authors.lastname: Schnettler
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ralston
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013537:Sutures / Q000706:statistics & numerical data; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: Abdominal wall thickness; cesarean wound complication; second trimester ultrasound; ultrasound prediction; wound risk factors