title: Abdominal Incision Selection for Cesarean Delivery of Women with Class III Obesity.
abstract: Objective The objective of this study was to evaluate cesarean outcomes, stratified by abdominal incision type, in women with class III obesity. Study Design We performed a retrospective cohort study of patients with class III obesity undergoing cesarean at our institution from 2010 to 2013 with singletons ≥ 34 weeks. Outcomes were compared between patients with transverse subpannicular and vertical abdominal incisions. The primary outcome was a wound composite (cellulitis, abscess, hematoma, seroma, or dehiscence). Other outcomes included transfusion, vertical hysterotomy, 5-minute Apgar < 7, and umbilical artery pH < 7.10. Results Of 423 patients, 364 had subpannicular transverse, 57 had vertical, and 2 had periumbilical transverse incisions (not analyzed). Although vertical incisions were associated with more wound complications (26.3 vs. 14.8%; p = 0.03), the difference became null after adjustment (adjusted odds ratios [aOR], 1.7; 95% confidence interval [CI], 0.7, 4.1). Vertical incisions were associated with increased risk of vertical hysterotomy (aOR 4.8; 95% CI, 2.2, 10.4), decreased risk of 5-minute Apgar < 7 (aOR, 0.06; 95% CI, 0.004, 0.9), and not statistically significantly associated with transfusion (aOR, 4.2; 95% CI, 0.9, 19.0) or umbilical artery pH < 7.1 (aOR, 0.42; 95% CI, 0.11, 1.7). Conclusions In women with class III obesity cesarean delivery via vertical abdominal incisions is associated with more maternal but less immediate neonatal complications.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Amelia L
authors.initials: AL
authors.lastname: Sutton
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Sanders
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Akila
authors.initials: A
authors.lastname: Subramaniam
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Jauk
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000407:Alabama; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000009:adverse effects / Q000379:methods*; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult