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

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.