Faculty Collaboration Database

The association of skin-incision type at cesarean with maternal and neonatal morbidity for women with multiple prior cesarean deliveries. Eur J Obstet Gynecol Reprod Biol 2015 Aug;191:121-4

Date

06/29/2015

Pubmed ID

26117440

DOI

10.1016/j.ejogrb.2015.06.009

Scopus ID

2-s2.0-84943607950 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVE: In women with multiple prior cesarean deliveries (CDs), vertical skin incisions are thought by some to result in better outcomes. The objective of this study was to compare maternal and neonatal outcomes according to the type of skin incisions among women with multiple prior CDs.

STUDY DESIGN: This was a secondary analysis of MFMU Cesarean Registry data. Women undergoing repeat CD with a viable singleton gestation and history of ≥2 prior CDs were included in this analysis. Women who had indications for urgent CD (e.g., cord prolapse) or suspected placenta accreta were excluded. Maternal and neonatal outcomes of women with 2, 3 and ≥4 prior CDs were compared by skin-incision type (transverse vs. vertical) using univariable and multivariable analyses.

RESULTS: 5007 women met the inclusion criteria. In univariable analysis, women with 2 prior CDs who had a vertical skin incision had shorter incision-to-delivery intervals (12.9 min vs. 14.1 min, p<0.001) but also higher rates of endometritis and composite adverse maternal outcomes (4.9% vs. 2.7%, p=0.001, 16.1% vs. 13.4%, p=0.026, respectively). Women with 3 prior CDs also had higher rates of composite adverse maternal outcomes (21.2% vs. 15.8%, p=0.042). In women with ≥4 prior CDs, prolonged hospitalization, composite adverse maternal outcomes, NICU admission and composite adverse neonatal outcomes also were higher with vertical skin incision (23.2% vs. 9.3%, p=0.005, 32.9% vs. 13.7%, p=0.001, 32.1% vs.19.6%, p=0.045, 32.9% vs.19.4%, p=0.024, respectively). In multivariable analyses, vertical skin incision remained associated with prolonged hospitalization and composite adverse maternal outcome among women with ≥4 prior CDs (aOR 3.40, CI 1.11-10.38, aOR=2.37, CI 1.02-5.55, respectively).

CONCLUSION: Vertical skin incision at the time of multiple repeat CD was not associated with better obstetric or perinatal outcomes and was associated among women with ≥4 prior CDs with a higher frequency of prolonged hospitalization and adverse maternal outcomes.

Author List

Palatnik A, Grobman WA

Author

Anna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Cesarean Section, Repeat
Cohort Studies
Endometritis
Female
Humans
Infant, Newborn
Infant, Newborn, Diseases
Intensive Care Units, Neonatal
Length of Stay
Male
National Institute of Child Health and Human Development (U.S.)
Operative Time
Postoperative Complications
Pregnancy
Proportional Hazards Models
Registries
United States