TITLE:
Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients: The Experience of a French Hospital from 2009 to 2014
AUTHORS:
Zelda Stewart, Patricia Dolley, Gaël Beucher, Anne Villot, Michel Dreyfus
KEYWORDS:
Cesarean, Supraumbilical, Obesity, Surgical Technique, Morbidity
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.7 No.10,
October
10,
2017
ABSTRACT: Aim: To describe our experience in supraumbilical cesarean deliveries in severely
and morbidly obese patients (body mass index > 35 kg/m2) with a voluminous
abdominal panniculus. Methods: 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. Results: Twenty
patients were included, for a total of 21 cesarean deliveries. Their mean body
mass index 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. Conclusions: 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.