Brocato Brian E, Thorpe Edwin M, Gomez Luis M, Wan Jim Y, Mari Giancarlo
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center, 853 Jefferson Avenue Suite E102, Memphis, TN 38163, USA.
J Pregnancy. 2013;2013:890296. doi: 10.1155/2013/890296. Epub 2013 Nov 20.
To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI) greater than 40 kg/m² who underwent a supraumbilical incision at the time of cesarean delivery.
We conducted a retrospective cohort study in women having a BMI greater than 40 kg/m² who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, n = 45) or Pfannenstiel (controls, n = 90) skin incisions.
Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.0-66.8), surgical drain placement (OR, 6.5; 95% CI, 2.6-16.2), estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.4-8.4), and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; P < .001) when compared to subjects with Pfannenstiel incisions (controls). There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.9-8.0).
In women with a BMI above 40 kg/m², supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.
评估体重指数（BMI）大于40kg/m²的女性在剖宫产时采用脐上切口行传统子宫切开术的风险及手术并发症。
我们对2007年至2011年在一家三级医疗机构进行剖宫产分娩单胎活产、BMI大于40kg/m²的女性进行了一项回顾性队列研究。比较了接受脐上垂直切口（队列，n = 45）或Pfannenstiel切口（对照组，n = 90）的患者的术中及术后结果。
与Pfannenstiel切口（对照组）的受试者相比，接受脐上切口的女性发生传统子宫切开术的风险更高（OR，24.6；95%CI，9.0 - 66.8）、放置手术引流管的风险更高（OR，6.5；95%CI，2.6 - 16.2）、估计失血量大于1升的风险更高（OR，3.4；95%CI，1.4 - 8.4）以及手术时间更长（97±38分钟对68±30分钟；P <.001）。接受脐上切口或Pfannenstiel切口的女性伤口并发症风险没有差异（OR，2.7；95%CI，0.9 - 8.0）。
对于BMI高于40kg/m²的女性，剖宫产时采用脐上切口与传统子宫切开术及手术并发症的风险增加有关。
