Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, the UQ-Ochsner Clinical School, the Ochsner Center for Outcomes and Health Services Research, and the Ochsner OB/GYN Residency, Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, Louisiana.
Obstet Gynecol. 2022 Jan 1;139(1):14-20. doi: 10.1097/AOG.0000000000004630.
To assess whether Pfannenstiel skin incision compared with vertical skin incision was associated with postcesarean delivery wound complications in morbidly obese women.
We assembled a retrospective cohort of patients with body mass index (BMI) of 40 or higher who delivered by cesarean between July 2012 and May 2019. The primary outcome was a composite wound morbidity (until 42 days postpartum) including wound separation, infection, and dehiscence. Secondary outcomes included individual composite components plus select maternal and neonatal outcomes. Comparisons of demographics and outcomes were made by χ2 and t test. Logistic regression was performed. Subgroup analysis was performed according to location of vertical skin incision in relation to the umbilicus.
A total of 3,901 patients were included. To account for imbalances in demographics between exposure groups, vertical and Pfannenstiel skin incision patients were matched in a 1:4 fashion for age, BMI, smoking status, and diabetes. The frequency of wound morbidity was 13.2% overall. There was no difference in the primary outcome when comparing Pfannenstiel with vertical skin incision (adjusted odds ratio [aOR] 1.5, 95% CI 0.8-2.8). Patients with a vertical skin incision were more likely to undergo vertical hysterotomy (aOR 138.7, 95% CI 46.9-410) and transfusion (aOR 5.4, 95% CI 1.8-16.5). When vertical skin incision was classified into supraumbilical and infraumbilical, and compared with Pfannenstiel skin incision, infraumbilical vertical skin incision was associated with increased wound morbidity (odds ratio [OR] 2.46, 95% CI 1.4-4.5) and wound infection (OR 2.5, 95% CI 1.4-4.6) compared with Pfannenstiel. Both types of vertical skin incision were associated with increased odds of vertical hysterotomy and transfusion when compared with Pfannenstiel.
In morbidly obese women who underwent cesarean delivery, the frequency of postoperative wound morbidity was similar after Pfannenstiel and vertical skin incisions.
评估耻骨上方皮肤横切口与传统的下腹直肌旁纵切口相比，是否会增加病态肥胖产妇剖宫产术后切口并发症。
本研究纳入了 2012 年 7 月至 2019 年 5 月期间因剖宫产分娩且 BMI≥40 的患者。主要结局为复合伤口并发症（产后 42 天内），包括伤口分离、感染和裂开。次要结局包括复合结局的各个组成部分，以及特定的产妇和新生儿结局。采用 χ2 和 t 检验比较人口统计学特征和结局。采用逻辑回归分析。根据垂直切口在脐部的位置进行亚组分析。
共纳入 3901 例患者。为了平衡暴露组之间的人口统计学差异，采用 1:4 的比例将垂直切口和耻骨上方横切口的患者按年龄、BMI、吸烟状况和糖尿病进行匹配。总的伤口并发症发生率为 13.2%。与垂直切口相比，耻骨上方横切口组的主要结局无差异（调整后的比值比[aOR]1.5，95%CI 0.8-2.8）。行垂直切口的患者更倾向于行垂直子宫切开术（aOR 138.7，95%CI 46.9-410）和输血（aOR 5.4，95%CI 1.8-16.5）。当将垂直切口分为上腹部和下腹部，并与耻骨上方横切口相比时，下腹部垂直切口与增加的伤口并发症（比值比[OR]2.46，95%CI 1.4-4.5）和伤口感染（OR 2.5，95%CI 1.4-4.6）相关，与耻骨上方横切口相比。与耻骨上方横切口相比，两种类型的垂直切口都与增加行垂直子宫切开术和输血的几率相关。
在接受剖宫产的病态肥胖女性中，耻骨上方横切口和传统的下腹直肌旁纵切口术后伤口并发症的发生率相似。
