{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:50Z","timestamp":1740126830784,"version":"3.37.3"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"crossref","award":["K23DA047476"],"award-info":[{"award-number":["K23DA047476"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>\n            Objective\u2003The aim of this study was to examine whether vertical versus transverse skin incision is associated with increased wound complications in superobese women undergoing cesarean.<\/jats:p><jats:p>\n            Study Design\u2003This is a secondary analysis of a retrospective cohort study that included women with a body mass index (BMI) \u2265 50\u2009kg\/m2 and a cesarean birth with documented skin incision type from 1\/1\/2008 to 12\/31\/2015 at a single academic medical center. The primary outcome was a composite of wound complications: infection requiring antibiotics including superficial cellulitis, deep and organ space infections requiring packing, vacuum placement or exploration and debridement in the operating room. Secondary outcomes included estimated blood loss (EBL), time from skin incision to delivery, need for classical or T-hysterotomy, prolonged hospital admission (&gt;4 days), and a composite of adverse neonatal outcomes. The primary exposure was skin incision type, transverse or vertical. Modified Poisson regression variance was used to adjust for differences in baseline characteristics.<\/jats:p><jats:p>\n            Results\u2003During the study period, 298 women underwent a cesarean with a known skin incision type. Vertical skin incision occurred in 25.8%. Women with a vertical skin incision were younger, had a higher BMI at delivery, had less weight gain in pregnancy, and were less likely to have labored prior to cesarean. Wound complications were not significantly more common in women with a vertical skin incision after adjusting for covariates (vertical 48.1 vs. transverse 29.4%, adjusted relative risk (aRR): 1.31, 95% confidence interval [CI]: 0.92\u20131.86). Compared with a transverse skin incision, vertical skin incision was associated with an increased risk for classical hysterotomy (67 vs. 17%, aRR: 2.96, 95% CI: 2.12\u20134.14), higher EBL, prolonged hospital stay, and composite neonatal morbidity. There were no statistically significant differences in the time from skin incision to delivery.<\/jats:p><jats:p>\n            Conclusion\u2003In superobese women, vertical skin incision was not associated with increased wound complications, but was associated with increased risk for classical hysterotomy.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1788-6381","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T07:18:57Z","timestamp":1646637537000},"page":"778-782","source":"Crossref","is-referenced-by-count":0,"title":["Skin Incision Selection in Superobese Women Undergoing Cesarean Birth"],"prefix":"10.1055","volume":"41","author":[{"given":"Jennifer L.","family":"Grasch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Indiana University Medical Center, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamia A.","family":"Alamri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah S.","family":"Osmundson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1001\/jama.2009.2014","article-title":"Prevalence and trends in obesity among US adults, 1999-2008","volume":"303","author":"K M Flegal","year":"2010","journal-title":"JAMA"},{"issue":"05","key":"ref2","first-page":"463","article-title":"The problem of the pannus: physician preference survey and a review of the literature on cesarean skin incision in morbidly obese women","volume":"33","author":"M C Smid","year":"2016","journal-title":"Am J Perinatol"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1097\/OGX.0000000000000469","article-title":"Body mass index 50\u2009kg\/m2 and beyond: perioperative care of pregnant women with superobesity undergoing cesarean delivery","volume":"72","author":"M C Smid","year":"2017","journal-title":"Obstet Gynecol Surv"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"924","DOI":"10.3109\/00016341003657884","article-title":"Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes","volume":"89","author":"M C Alanis","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"14","key":"ref5","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1055\/s-0035-1564883","article-title":"Extreme obesity and postcesarean wound complications in the maternal-fetal medicine unit cesarean registry","volume":"32","author":"M C Smid","year":"2015","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/AOG.0b013e318297ec6c","article-title":"Perioperative oxygen supplementation and surgical site infection after cesarean delivery: a randomized trial","volume":"122","author":"N Duggal","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/AOG.0000000000001064","article-title":"Obstetric surgical site infections: 2 grams compared with 3 grams of cefazolin in morbidly obese women","volume":"126","author":"H K Ahmadzia","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/AOG.0000000000001118","article-title":"Skin preparation for prevention of surgical site infection after cesarean delivery: a randomized controlled trial","volume":"126","author":"I M Ngai","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/jog.13605","article-title":"Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification","volume":"44","author":"R Zeki","year":"2018","journal-title":"J Obstet Gynaecol Res"},{"key":"ref10","first-page":"952","article-title":"Vertical skin incisions and wound complications in the obese parturient","volume":"102","author":"P D Wall","year":"2003","journal-title":"Obstet Gynecol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ejogrb.2014.12.014","article-title":"Suprapannus transverse caesarean section incision in morbidly obese women","volume":"186","author":"L I Stirrat","year":"2015","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"03","key":"ref12","first-page":"890296","article-title":"The effect of cesarean delivery skin incision approach in morbidly obese women on the rate of classical hysterotomy","volume":"2013","author":"B E Brocato","year":"2013","journal-title":"J Pregnancy"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1097\/AOG.0000000000002257","article-title":"Trial of labor compared with cesarean delivery in superobese women","volume":"130","author":"J L Grasch","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ejogrb.2010.07.043","article-title":"Abdominal surgical incisions and perioperative morbidity among morbidly obese women undergoing cesarean delivery","volume":"154","author":"J Bell","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"097","DOI":"10.1055\/s-0038-1667287","article-title":"Pfannenstiel versus vertical skin incision for cesarean delivery in women with class III obesity: a randomized trial","volume":"36","author":"C Marrs","year":"2019","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1055\/s-0031-1295637","article-title":"Type of skin incision and wound complications in the obese parturient","volume":"29","author":"M McLean","year":"2012","journal-title":"Am J Perinatol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/AOG.0000000000000384","article-title":"Extreme obesity and postcesarean maternal complications","volume":"124","author":"D M Stamilio","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1055\/s-0035-1570339","article-title":"Abdominal incision selection for cesarean delivery of women with class III obesity","volume":"33","author":"A L Sutton","year":"2016","journal-title":"Am J Perinatol"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.3109\/14767058.2011.653422","article-title":"Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery","volume":"25","author":"L L Thornburg","year":"2012","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1788-6381.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:18:23Z","timestamp":1730801903000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1788-6381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,4]]},"references-count":19,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2024,4,10]]},"published-print":{"date-parts":[[2024,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1788-6381","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2022,3,4]]},"published":{"date-parts":[[2022,3,4]]}}}