NYMC Faculty Publications

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

DOI

10.1097/AOG.0000000000002806

Journal Title

Obstetrics and Gynecology

First Page

619

Last Page

623

Document Type

Article

Publication Date

September 2018

Department

Obstetrics and Gynecology

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.

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