Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients:The Experience of a French Hospital from 2009 to 2014

摘要

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.