Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Objective: The aim of this study is to compare between Pfannenstiel incision and a higher transverse incision used to preform cesarean delivery (CD) 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 CD through a Pfannenstiel incision, and the other 50 patients underwent delivery via a higher transverse suprapannicular incison.The included patients were observed intraoperative and 1 and 6 weeks postoperatively.The primary outcome is to compare composite maternal morbidity (wound complications within 6 weeks including cellulitis, wound abscess, wound separation or dehiscence, hematoma, seroma formation, endometritis).Secondary outcomes include: total operative time from skin incision to fetal delivery, severity of pain and amount of pain medications utilized in the first 48 hours post procedure, hemoglobin drop, and incidence of low transverse uterine incisions (hysterotomy).Results: In our study, we found a significant reduction in the mean time taken for fetal delivery, hemoglobin drop, pain score, and the rate of wound complications 1 week postoperative, but the APGAR score at 5 minutes was also reduced in the suprapannicular group. However, regarding the total operative time, surgical complications, need for NICU, intraoperative complications, need for opioid analgesia and wound complications 6 weeks postoperatively there was no statistically significant difference. Conclusion: Higher incidence of wound complications is associated with the usual Pfannenstiel incision in obese parturients, the use of high transverse skin incisions may reduce the risk of wound complications in this population.A larger study with larger population number is recommended

Issued also as CD