Cesarean section in morbidly obese women: supra or subumbilical transverse incision?

Abstract

The obstetrician is more and more frequently faced with the decision to perform a cesarean section in obese women. We describe a technique of supra or subumbilical transverse cesarean section (depending on the height of the projection of the upper edge of the pubic symphysis) specifically designed for morbidly obese women with a voluminous panniculus. We evaluated feasibility and associated morbidity in a retrospective descriptive series of 18 patients operated between 2003 and 2008. We assessed the quality of access to the lower uterine segment and facility to extract the fetus. The mean body mass index was 47.7 kg/m(2) (range 40.1-60.8). The incision was subumbilical in 13 women (72.2%) and supraumbilical in 27.7%. With this technique, the exposition, the section of the lower uterine segment, and extraction of the baby are simple. It can be easily generalized and quickly learnt.

Care of Women with Obesity in Pregnancy

“…158,159 Evidence is conflicting about whether the risk of surgical site infections is increased, 151,157,160,161 decreased 155 or unchanged 154,[162][163][164] with vertical suprapanniculus incisions. The alternative suprapanniculus approach is to use a transverse as opposed to a vertical skin incision 165 but there is a paucity of evidence on clinical outcomes following this approach.…”

Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients: The Experience of a French Hospital from 2009 to 2014

“…Tixier et al led a descriptive retrospective study in [2003][2004][2005][2006][2007][2008] in France in which they described the two types of skin incisions to favor with severe obese patients (BMI > 40) [15]. The aim was to improve the access to the lower uterine segment by making the incision two finger-widths above the projection of the pubic symphysis.…”

“…With 20 patients, this work is the largest French study that describes this type of specific incision and its complications. Tixier et al had indeed 18 patients but only 5 of them had a transverse supraumbilical incision [15]. Stirrat et al presented a series of 10 morbidly obese patients operated also with this technique and suggested that a suprapannus incision may benefit their surgical and anesthetic management [27].…”

Delivery of the Obese Gravida

“…14 Thepannuscanbeleft in its physiological position and a skin incisioncanbemadeonthepannustissuein alocationthatis2fingerbreadthsabovethe anatomiclevelofthepubicsymphysis.This type of periumbilical incision allows for improved access to the lower uterine segment and is associated with minimal postoperative wound complications. 24 When using this technique, care must be taken to not create an incision that enters, exits, and reenters the pannus creating a buttonhole defect in the anterior abdominal wall.…”