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Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients

The prevalence of obesity is increasing worldwide. And obese fertile women appear to have more adverse pregnancy outcomes: increased risks of gestational hypertension, preeclampsia, gestational diabetes, anemia, induction of labor, instrumental delivery, cesarean section, and severe postpartum hemorrhage. And some studies have shown that when they have a cesarean delivery, these women have more postoperative complications compared to non-obese patients. It is why the gynecological community has been developing alternative surgical technique to try to diminish the complication risks, the current reference being the transverse subumbilical incision. These techniques differ from the skin incision for both type and site: transverse or vertical, subumbilical or supraumbilical. To the authors’ knowledge, there is no consensus on the surgical approach nor choice of abdominal incision in the obese women undergoing cesarean delivery, so in this paper they aimed to describe their experience in supraumbilical cesarean deliveries in severely and morbidly obese patients (body mass index > 35 kg/m2) with a voluminous abdominal panniculus. 

They conducted a retrospective study in France between January 2009 and May 2014. Every woman who underwent a cesarean delivery with a supraumbilical incision was included through her digital medical record. A senior doctor made the decision for a supraumbilical skin incision after careful examination of the patient’s anatomical conditions. Twenty patients were included, for a total of 21 cesarean deliveries. Their mean body mass index was 50 (40 - 61.7). Nineteen of them (95.0%) had an abdominal panniculus in supine “apron” position. Twelve patients (57.1%) had a scarred uterus. During the cesarean section, 14 (66.7%) had a segmentary hysterotomy. The median operative time was 49 minutes (32 - 70). Four patients (19.1%) had a postpartum hemorrhage and 4 (19.1%) a postpartum infectious complication, none of which were severe. 

In summary, in this specific population of severely obese women undergoing cesarean procedures, variations in anatomy require each patient’s incision choice to be individualized. In women with a voluminous panniculus, the supraumbilical skin incision seems to offer an adequate exposure to the peritoneal cavity and the lower uterine segment, therefore allowing to safely carry out the procedure. However, a prospective study on a larger sample remains necessary to compare this technique to the classical cesarean procedure.

Article by Zelda Stewart, et al, from Caen University Hospital, Caen, France.

Full access: http://mrw.so/2JZmbE

Image by Christina Trader, from Flickr-cc.

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  1. Laura Patterson2021年12月15日 15:19

    Nice post. Well what can I say is that these is an interesting and very informative topic on ostomy effluent

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