The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity

Caroline C. Marrs, Hind N. Moussa, Baha M. Sibai, Sean C. Blackwell

Research output: Contribution to journalArticle

  • 21 Citations

Abstract

Objective We sought to evaluate the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). Study Design Morbidly obese women (body mass index <40 kg/m2) undergoing primary CD at <24 weeks' gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical skin incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. Results In all, 3200 women were studied: 2603 (81%) had a transverse incision and 597 (19%) had a vertical incision. Vertical skin incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17-0.62; P <.001) but not with composite adverse maternal outcome (adjusted odds ratio, 0.72; 95% confidence interval, 0.41-1.25; P =.24). Conclusion In morbidly obese women undergoing a primary CD, vertical skin incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of skin incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Volume210
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Morbid Obesity
Skin
Wounds and Injuries
Odds Ratio
Confidence Intervals
Seroma
Selection Bias
Pulmonary Edema
Wound Infection
Hysterectomy
Hematoma
Observational Study
Registries
Body Mass Index
Randomized Controlled Trials
Logistic Models
Regression Analysis
Pregnancy

Keywords

  • cesarean delivery
  • morbid obesity
  • obesity
  • skin incision
  • wound complication

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{c3d14c4f3b054b50800bc3c05db3bdf6,
title = "The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity",
abstract = "Objective We sought to evaluate the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). Study Design Morbidly obese women (body mass index <40 kg/m2) undergoing primary CD at <24 weeks' gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical skin incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. Results In all, 3200 women were studied: 2603 (81%) had a transverse incision and 597 (19%) had a vertical incision. Vertical skin incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17-0.62; P <.001) but not with composite adverse maternal outcome (adjusted odds ratio, 0.72; 95% confidence interval, 0.41-1.25; P =.24). Conclusion In morbidly obese women undergoing a primary CD, vertical skin incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of skin incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.",
keywords = "cesarean delivery, morbid obesity, obesity, skin incision, wound complication",
author = "Marrs, {Caroline C.} and Moussa, {Hind N.} and Sibai, {Baha M.} and Blackwell, {Sean C.}",
year = "2014",
doi = "10.1016/j.ajog.2014.01.018",
volume = "210",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity

AU - Marrs,Caroline C.

AU - Moussa,Hind N.

AU - Sibai,Baha M.

AU - Blackwell,Sean C.

PY - 2014

Y1 - 2014

N2 - Objective We sought to evaluate the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). Study Design Morbidly obese women (body mass index <40 kg/m2) undergoing primary CD at <24 weeks' gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical skin incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. Results In all, 3200 women were studied: 2603 (81%) had a transverse incision and 597 (19%) had a vertical incision. Vertical skin incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17-0.62; P <.001) but not with composite adverse maternal outcome (adjusted odds ratio, 0.72; 95% confidence interval, 0.41-1.25; P =.24). Conclusion In morbidly obese women undergoing a primary CD, vertical skin incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of skin incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.

AB - Objective We sought to evaluate the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). Study Design Morbidly obese women (body mass index <40 kg/m2) undergoing primary CD at <24 weeks' gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical skin incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. Results In all, 3200 women were studied: 2603 (81%) had a transverse incision and 597 (19%) had a vertical incision. Vertical skin incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17-0.62; P <.001) but not with composite adverse maternal outcome (adjusted odds ratio, 0.72; 95% confidence interval, 0.41-1.25; P =.24). Conclusion In morbidly obese women undergoing a primary CD, vertical skin incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of skin incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.

KW - cesarean delivery

KW - morbid obesity

KW - obesity

KW - skin incision

KW - wound complication

UR - http://www.scopus.com/inward/record.url?scp=84897426706&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897426706&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2014.01.018

DO - 10.1016/j.ajog.2014.01.018

M3 - Article

VL - 210

JO - American Journal of Obstetrics and Gynecology

T2 - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 4

ER -