PLD.29 Accessing the lower segment of the uterus via transverse supra-umbilical cutaneous incision in a patient with body mass index of 67.

UNLABELLED: : According to the WHO (2008), 25.2% of women in the UK above 20 years were obese and this number is increasing. Obesity increases risk of many complications during pregnancy and labour, including emergency caesarean section and wound infection (Sebire et al., 2001). In patients with a voluminous panniculus, problems arise during a caesarean section with the commonly used Pfannenstiel incision: a distorted abdominal wall contour reducing access to the lower segment when the panniculus is lifted and post-surgical wound infection beneath the pannus. An alternative midline incision is associated with wound dehiscence and increased post-surgical pain (Wall et al., 2003). Here we present a case in which we successfully performed a transverse supra-umbilical incision as described by Tixier et al. (2009), to access the lower uterine segment of a patient with a BMI of 67 (193 kg) during an emergency caesarean section. The patient was consulted prior to surgery and indicated she would be happy with the aesthetic consequences. Wound healing was satisfactory and the patient was discharged 5 days postnatally. No complications ensued. Learning from this, we would advocate use of cutting diathermy for the subcutaneous fascia to reduce bleeding and St Mark's retractors to facilitate access to the pelvis. Two assistants are invaluable. We recommend this procedure for caesarean section on the super obese (BMI >50) woman with a voluminous panniculus.

REFERENCES: Tixier H, et al. Acta Obstetricia et Gynecologica 2009;88:1049-1052 Sebire NJ, et al. Int J Obes 2001;25:1175-82 Wall PD, et al. Obstet Gynecol 2003;102:952-6.