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

Abstract

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.

In Brief

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