Comparison between Pfannenstiel Incision and higher transverse Cohen incision, during elective Cesarean section, a randomized controlled trial among morbidly obese parturients

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Shaza Saad Allah
Rasha Kamel
Ehab M.Soliman
Mohamed Momtaz


Obesity-cesarean delivery-wound infection-suprapannicular incision-Pfannenstiel incision


Objectives: The purpose of this investigation was to compare between Pfannenstiel incision and a higher transverse incision used to perform cesarean section (CS) in obese patients with BMI 35 kg/m2 or more, regarding the maternal morbidity including wound infection, dehiscence, seroma formation, and the need for further management.
Material and methods: In this study 100 obese women with BMI of 35kg/m2 or more, pregnant in their third trimester, attending for elective cesarean delivery. Fifty of them underwent CS through a Pfannenstiel incision, and the other 50 patients underwent delivery via a higher transverse suprapannicular incision 3 centimeters below the level of the anterior superior iliac spines. If a pannus
is present, it should be kept in its natural position (not retracted) to provide room for the incision.
Results: In our investigation, we found a significant reduction in the mean incision to fetal delivery time, hemoglobin drop, pain score, and the rate of wound complications 1 week postoperative, but the APGAR score at 5 minutes was reduced in the suprapannicular group. However, regarding the total operative time, surgical complications, need for neonatal intensive care unit, intraoperative
complications, need for opioid analgesia and wound complications 6 weeks postoperatively there was no statistically significant difference.
Conclusion: In obese parturients, the standard Pfannenstiel incision is linked to a higher frequency of wound problems; higher transverse skin incisions may lower the risk of wound complications in this group.

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1. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. Bmj. 2017 Feb 8; 356.
2. Rogers AJ, Harper LM, Mari G. A conceptual framework for the impact of obesity on risk of cesarean delivery. American journal of obstetrics and gynecology. 2018 Oct 1; 219(4):356-63.
3. Marrs CC, Moussa HN, Sibai BM, et al., Removed: The relationship between primary cesarean delivery skin incision type and wound
complications in women with morbid obesity. American Journal of Obstetrics & Gynecology. 2014 Apr 1; 210(4):319.
4. Khawla Ali Majeed, Abbas A. J. AL - Salihi, et al., Maternal Obesity And Factors Associated With Mode Of Delivery. Int. J. of Adv.2018 :
5. Conner SN, Verticchio JC, Tuuli MG, et al., Maternal obesity and risk of post-cesarean wound complications. American journal of perinatology. 2014 Apr; 31(4):299.
6. Smid MC, Smiley SG, Schulkin J, et al., The problem of the pannus: physician preference survey and a review of the literature on cesarean skin incision in morbidly obese women. American journal of perinatology. 2016 Apr; 33(05):463-72.
7. Igwe D, Stanczyk M, Tambi J,et al., Panniculectomy adjuvant to obesity surgery. Obesity surgery. 2000 Dec; 10(6):530-9.
8. Brocato BE, Thorpe EM, Gomez LM, et al., The effect of cesarean delivery skin incision approach in morbidly obese women on the rate of classical hysterotomy. Journal of pregnancy. 2013 Jan 1; 2013.
9. Lakhi NA, Williamson K, Moretti ML. An original suprapannicular incision technique for cesarean delivery in the morbidly obese
parturient. Obstetrics & Gynecology. 2018 Sep 1; 132(3):619-23.
10. Saha SP, Bhattarcharjee N, Mahanta SD, et al., A randomized comparative study on modified JoelCohen incision versus Pfannenstiel incision for cesarean section. Journal of the Turkish German Gynecological Association. 2013; 14(1):28.
11. Tixier H, Thouvenot S, Coulange L, et al., Cesarean section in morbidly obese women: supra or subumbilical transverse incision?. Acta obstetricia et gynecologica Scandinavica. 2009 Sep; 88(9):1049-52.
12. Stewart Z, Dolley P, Beucher G, et al.,Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients: The
Experience of a French Hospital from 2009 to 2014. Open Journal of Obstetrics and Gynecology. 2017 Oct 9; 7(10):1024.
13. Walton RB, Shnaekel KL, Ounpraseuth ST, et al., High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study. The Journal of MaternalFetal & Neonatal Medicine. 2019 Mar 4; 32(5):781-5.
14. Gizzo S, Andrisani A, Noventa Met al., Caesarean section: could different transverse abdominal incision techniques influence
postpartum pain and subsequent quality of life? A systematic review. PLoS One. 2015 Feb 3; 10(2):e0114190.
15. Abuelghar WM, El-Bishry G, Emam LH. Caesarean deliveries by Pfannenstiel versus JoelCohen incision: A randomised controlled trial. Journal of the Turkish German Gynecological Association. 2013; 14(4):194.
16. Elsayed HM, Elmekkawi SF, Elkotb AM, et al., Transverse Supraumbilical versus Pfannenstiel Incision for Cesarean Section in Morbidly Obese Women “A Randomized Controlled Trial”. QJM: An International Journal of Medicine. 2020 Mar 1; 113(Supplement_1):hcaa056-031.