The Well-Rounded Mama

Researchers messed up the final outcome of earlier Cesarean incision study! Transverse (side-to-side) incisions are really better after all for high BMI women! In general, there is a great deal to be said for an incision not buried under the pangs of unwanted fat, so that oxygen can help keep the wound dry. They meant well, but they were operating from flawed assumptions and obsolete teaching.

In other words, they hadn’t actually researched whether or not vertical was better in high-BMI women, they assumed it was just predicated on their biases about extra fat bodies. It’s been written that transverse stomach incisions made under the pannicular fold can be found in “a warm, moist, anaerobic environment associated with impaired bacteriostasis. A “veritable bacteriologic cesspool”? What a disrespectful and terrible way for those obstetric text messages to spell it out it.

While deep pores and skin folds will often predispose to skin yeast and infections, it generally does not always and surgical incisions should not be based on conditions assumed to exist. Rather, caution providers should be aware of the likelihood and make decisions predicated on actual evidence of problems rather than an assumption of pathology.

As noted, Cesarean incision choice for very heavy women was usually based on traditional teachings and biased assumptions. When someone actually took the time to research these hypotheses, however, it was discovered that vertical incisions were no better and in some studies were far more risky actually. Let’s execute a quick overview of the medical literature with this topic. Our results also support the use of Pfannenstiel incisions in obese patients with a huge panniculus. D’heureux-Jones 2001 also discovered that vertical incisions were associated with higher loss of blood and poorer outcomes. They recommended a Pfannenstiel incision too. In some scholarly studies the findings were more dramatic.

In Wall 2003, vertical incisions presented 12x the risk for wound complications compared to transverse incisions. TWELVE TIMES the chance. That’s a tremendous difference. Thornburg 2012 discovered that the majority of wound complications (WC) were within the vertical incision group (45.7% rate in vertical incisions, vs. That is clearly a very factor. In morbidly obese women both infectious and separation-type WC are more common in vertical than low transverse incisions; transverse should be preferred therefore. Critics would point out that a quantity of studies did not find a statistically factor between vertical vs.

Many researchers cite these studies to argue that there surely is no difference between incisions and the choice should be completely still left to the surgeon’s choice. However, if they read the full text of these scholarly studies, the data usually showed a very clear pattern towards more complications with vertical incisions. Bell 2011 found wound complications in 14.6% of the vertical incision group vs. Vermillion 2000 found a 23% wound contamination rate in the vertical group vs. McLean 2012 found a 20% rate of wound separation in the vertical group vs. Sutton 2016 found a 26.3% rate of wound problems in the vertical group vs.

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The fact that the differences didn’t rise to statistical significance doesn’t mean that vertical incisions were just as safe; it just means these studies were simply underpowered showing statistical significance between your organizations. Larger studies do have to be done, but the majority of the data we have up to now suggests that vertical incisions perform no better and frequently perform worse in obese women. Low transverse incisions are usually associated with better results.

Bottom series vertical incisions are associated with an increase of rates of wound problems, loss of blood, and infections in obese women, very obese women even, as we have discussed thoroughly before. In addition, vertical incisions are far more scarring and challenging to a woman’s self-esteem and really should ideally be avoided on that basis alone. It is also well worth noting that even though the best incision for each woman’s unique anatomy and situation must be judged on a person basis, low transverse incisions have been used effectively even in women of 400-500 pounds without poor final results.

Another problem is that several of these studies (Bell 2011, Alanis 2010, Sutton 2016) also have shown that whenever vertical pores and skin incisions are done, they result in an increased rate of vertical uterine incisions (hysterotomies). Bell 2011 found that nearly 2/3 of all vertical skin incisions in obese women resulted in a vertical uterine incision as well. A vertical uterine incision results in a riskier surgery, with an increase of blood loss, a far more difficult recovery, and a higher rate of uterine rupture in future pregnancies.