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Vertical Skin Incisions and Wound Complications in the Obese Parturient

Wall, Peter D. MD; Deucy, Erin E. MD; Glantz, J. Christopher MD, MPH; Pressman, Eva K. MD

Original Research

OBJECTIVE: To examine the relationship between the type of skin incision and postoperative wound complications in an obese population.

METHODS: A hospital-based perinatal database was used to identify women with a body mass index (BMI) of greater than 35 undergoing their first cesarean delivery. Hospital and outpatient medical records were reviewed for the following variables: age, insurance status, BMI, gestational age at delivery, birth weight, smoking history, prior abdominal surgery, existing comorbidities, preoperative hematocrit, chorioamnionitis, duration of labor and membrane rupture, dilation at time of cesarean delivery, type of skin and uterine incision, estimated blood loss, operative time, antibiotic prophylaxis, use of subcutaneous drains or sutures, endometritis, and length of stay. The primary outcome variable was any wound complication requiring opening the incision. Multiple logistic regression analysis was completed to determine which of these factors contributed to the incidence of wound complications.

RESULTS: From 1994 to 2000, 239 women with a BMI greater than 35 undergoing a primary cesarean delivery were identified. The overall incidence of wound complications in this group of severely obese patients was 12.1%. Factors associated with wound complications included vertical skin incisions (odds ratio [OR] 12.4, P < .001) and endometritis (OR 3.4, P = .03). A high preoperative hematocrit was protective (OR .87, P = .03). No other factors were found to impact wound complications.

CONCLUSION: Primary cesarean delivery in the severely obese parturient has a high incidence of wound complications. Our data indicate that a vertical skin incision is associated with a higher rate of wound complications than a transverse incision.

Vertical skin incisions are associated with a higher rate of wound complications in severely obese women undergoing cesarean delivery.

Department of Obstetrics and Gynecology, Strong Memorial Hospital, University of Rochester School of Medicine, Rochester, New York.

Address reprint requests to: Peter D. Wall, MD, Strong Memorial Hospital, University of Rochester, Department of Obstetrics and Gynecology, Box 668, 601 Elmwood Avenue, Rochester, NY 14642; E-mail:

Received April 25, 2003. Received in revised form June 25, 2003. Accepted July 10, 2003.

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.