The Problem of the Pannus: Physician Preference Survey and a Review of the Literature on Cesarean Skin Incision in Morbidly Obese Women.
OBJECTIVE
This study aims to determine preferences of a nationally representative sample of obstetrician/gynecologists (OB/GYNs) regarding cesarean delivery (CD) incision practices for women with morbid obesity (body mass index ≥ 40 kg/m(2)).


METHODS
We conducted an online survey using the American College of Obstetricians and Gynecologists database. We compared physician demographics, practice characteristics, and CD incision type preference.


RESULTS
After exclusion of ineligible participants, 247 OB/GYNs completed the survey (42% response rate). In nonemergency CD of morbidly obese women, 84% of physicians preferred a Pfannenstiel skin incision (67% preferring taping the pannus; 17% without taping the pannus). In emergency CD, 66% preferred a Pfannenstiel incision (46% without taping the pannus; 20% with taping the pannus) and 20% a vertical incision. For both emergency and nonemergency CD, there was no difference in incision type preferences by provider years in practice, practice scope, or number of CD performed each year.


CONCLUSIONS
Given the preference of a Pfannenstiel incision with taping the pannus during CD of morbidly obese women, further investigation is needed to assess the risks and benefits of this incision and the practice of elevating the pannus.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Marcela C
MC
Smid
School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Sarah G
SG
Smiley
Department of Research, American College of Obstetricians and Gynecologists, Washington, District of Columbia.
Jay
J
Schulkin
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
David M
DM
Stamilio
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Rodney K
RK
Edwards
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Alison M
AM
Stuebe
D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D009767:Obesity, Morbid; D009774:Obstetrics; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection; D011795:Surveys and Questionnaires