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An Original Suprapannicular Incision Technique for Cesarean Delivery in the Morbidly Obese Parturient

Lakhi, Nisha A., MD; Williamson, Katherine, DO; Moretti, Michael L., MD

doi: 10.1097/AOG.0000000000002806
Procedures and Instruments: PDF Only

BACKGROUND: Obese patients are at an increased risk of cesarean delivery and its associated wound complications. We present an alternative incision technique for obese parturients that avoids making a Pfannenstiel incision under the panniculus while still providing access to the lower uterine segment.

TECHNIQUE: For our technique, an assistant uses Allis clamps to exert caudal traction on the patient's panniculus and a transverse skin incision is made under the umbilicus, 3 cm below the line joining the anterosuperior iliac crests. On entry to the abdominal cavity, a wound retractor is placed to optimize access to the lower uterine segment so that a low transverse uterine incision can be made.

EXPERIENCE: We have used this incision technique on 17 obese patients with no incidence of intraoperative complications, no requirement to perform a vertical hysterotomy incision, and no postoperative wound infections.

CONCLUSION: Our technique is a feasible alternative incision for obese parturients that avoids making a subpannicular Pfannenstiel incision and still allows for good access to the lower uterine segment.

For obese parturients, a high-transverse suprapannicular skin incision avoids a subpannicular Pfannenstiel incision and still allows access to the lower uterine segment.

Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, and the Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York.

Corresponding author: Nisha A. Lakhi, MD, Richmond University Medical Center, Department of Obstetrics and Gynecology, 355 Bard Avenue, Staten Island, NY 10310; email: nlakhi@yahoo.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 17, 2018

Received in revised form June 08, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.