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

Aim: To describe our experience in supraumbilical cesarean deliveries in severelyand morbidly obese patients (body mass index u003e 35 kg/m2) with a voluminousabdominal panniculus. Methods: A retrospective study in France betweenJanuary 2009 and May 2014. Every woman who underwent a cesarean delivery with asupraumbilical incision was included through her digital medical record. Asenior doctor made the decision for a supraumbilical skin incision aftercareful examination of the patient’s anatomical conditions. Results: Twentypatients were included, for a total of 21 cesarean deliveries. Their mean bodymass index 50 (40 - 61.7). Nineteen of them (95.0%) had an abdominal panniculusin supine “apron” position. Twelve patients (57.1%) had a scarred uterus.During the cesarean section, 14 (66.7%) had a segmentary hysterotomy. The medianoperative time was 49 minutes (32 - 70). Four patients (19.1%) had a postpartumhemorrhage and 4 (19.1%) a postpartum infectious complication, none of whichwere severe. Conclusions: In this specific population of severely obesewomen undergoing cesarean procedures, variations in anatomy require eachpatient’s incision choice to be individualized. In women with a voluminous panniculus thesupraumbilical skin incision seems to offer an adequate exposure to theperitoneal cavity and the lower uterine segment, therefore allowing to safelycarry out the procedure. However a prospective study on a larger sample remainsnecessary to compare this technique to the classical cesarean procedure.