Key result
A higher transverse Cohen incision reduced wound infections at 1 week postpartum compared to a Pfannenstiel incision (12.0% vs 30.0%, p=0.027) in morbidly obese women undergoing cesarean section.
Why the study?
The study was conducted to compare Pfannenstiel incision with a higher transverse incision for cesarean section in obese patients regarding maternal morbidity, including wound complications.
Does a higher transverse suprapannicular incision reduce composite maternal morbidity compared to a Pfannenstiel incision in morbidly obese parturients undergoing elective cesarean section?
RCT (n=100)
Computerized randomization
No
Does a higher transverse suprapannicular incision reduce composite maternal morbidity compared to a Pfannenstiel incision in morbidly obese parturients undergoing elective cesarean section?
A higher transverse suprapannicular incision reduces early wound complications, blood loss, and pain compared to a Pfannenstiel incision in morbidly obese women undergoing elective cesarean section.
Higher transverse incision reduces early wound complications versus Pfannenstiel in obese cesarean patients; supports its consideration as an alternative in this population.
Objectives: The purpose of this investigation was to compare between Pfannenstiel incision and a higher transverse incision used to perform cesarean section (CS) in obese patients with BMI 35 kg/m2 or more, regarding the maternal morbidity including wound infection, dehiscence, seroma formation, and the need for further management.Material and methods: In this study 100 obese women with BMI of 35kg/m2 or more, pregnant in their third trimester, attending for elective cesarean delivery.Fifty of them underwent CS through a Pfannenstiel incision, and the other 50 patients underwent delivery via a higher transverse suprapannicular incision 3 centimeters below the level of the anterior superior iliac spines.If a pannus is present, it should be kept in its natural position (not retracted) to provide room for the incision.Results: In our investigation, we found a significant reduction in the mean incision to fetal delivery time, hemoglobin drop, pain score, and the rate of wound complications 1 week postoperative, but the APGAR score at 5 minutes was reduced in the suprapannicular group.However, regarding the total operative time, surgical complications, need for neonatal intensive care unit, intraoperative complications, need for opioid analgesia and wound complications 6 weeks postoperatively there was no statistically significant difference.Conclusion: In obese parturients, the standard Pfannenstiel incision is linked to a higher frequency of wound problems; higher transverse skin incisions may lower the risk of wound complications in this group.
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A 2023 study conducted an RCT in Morbid obesity in pregnancy requiring elective Cesarean section (n=100). Higher transverse Cohen incision (suprapannicular) vs. Pfannenstiel incision (infrapannicular) was evaluated on Wound infection at 1 week postpartum (p=0.027). A higher transverse Cohen incision reduced wound infections at 1 week postpartum compared to a Pfannenstiel incision (12.0% vs 30.0%, p=0.027) in morbidly obese women undergoing cesarean section.
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