BACKGROUND AND PURPOSE:

• Martin et al. (Obstetrics & Gynecology, 2021) assessed whether Pfannenstiel or vertical skin incision for cesarean resulted in fewer wound complications in women with morbid obesity

METHODS:

• Retrospective cohort study
• Participants
  • BMI ≥40
  • Cesarean delivery between 2012 and 2019
• Exposures
  • Unexposed: Pfannenstiel skin incision
  • Exposed: Vertical skin incision
• Study design
  • To account for imbalances in demographics between exposure groups, vertical and Pfannenstiel skin incision patients were matched 1:4 for age, BMI, smoking status, and diabetes
  • Comparisons of demographics and outcomes were made by χ2 and t test
  • Subgroup analysis was performed according to location of vertical skin incision in relation to the umbilicus
• Primary outcome
  • Composite wound morbidity (until 42 days postpartum) including wound separation, infection, and dehiscence
• Secondary outcomes
  • Individual composite components
  • Maternal and neonatal outcomes

RESULTS:

• Pfannenstiel incision: 489 patients | Vertical incision: 123 patients
• Overall frequency of wound morbidity: 13.2%
• There was no difference in the primary outcome when comparing Pfannenstiel with vertical skin incision
  • Adjusted odds ratio (aOR) 1.5 (95% CI, 0.8 to 2.8)
• Patients with a vertical skin incision were more likely to undergo
  • Vertical hysterotomy: aOR 138.7 (95% CI, 46.9 to 410)
  • Transfusion: aOR 5.4 (95% CI, 1.8 to 16.5)

Subgroup Analysis: Vertical incisions classified as Supraumbilical and Infraumbilical

• Infraumbilical vertical skin incision vs Pfannenstiel was associated with
  • Increased wound morbidity: OR 2.46 (95% CI, 1.4 to 4.5)
  • Increased wound infection: OR 2.5 (95% CI, 1.4 to 4.6)
• Supraumbilical vertical skin incision vs Pfannenstiel was associated with
  • Increased risk of wound separation: OR 8.9 (95% CI,1.2 to 64.7)
  • Increased NICU admission: OR 2.6 (95% CI,1.2 to 6)
• Compared to Pfannenstiel, both types of vertical skin incision were associated with increased odds of vertical hysterotomy and transfusion

CONCLUSION:

• The frequency of post-cesarean wound morbidity in women with morbid obesity was similar if the incision performed was a Pfannenstiel or a vertical skin incision
  • However, vertical skin incisions were associated with increased odds of hysterotomy and transfusion need
  • Compared to Pfannenstiel, infraumbilical vertical skin incision was associated with increased wound morbidity
• Limitations include the limited number of vertical incisions which may have limited the power of the study to find a difference between vertical and Pfannenstiel incisions
• The authors state

…potential benefit gained from fewer wound complications after supraumbilical vertical skin incision may come at the expense of increased odds of vertical hysterotomy and the implications on future childbearing should be considered 

Learn More – Primary Sources:

Association of Skin Incision Type With Postoperative Cesarean Delivery Complications in Morbidly Obese Patients

Related ObG Topics:

RCT Results: Prophylactic Negative Pressure Wound Therapy to Prevent SSIs in Obese Women Following Cesarean

Increasing BMI and Adverse Pregnancy Outcomes: What Are the Risks?

What is the Best Practices Prevention Bundle for Post Cesarean Infection?

RCT Results: Closed Incision Negative Pressure Wound Therapy vs Standard Dressing Among Women with Obesity Undergoing Cesarean