Conference Coverage

No clear winner in Pfannenstiel vs. vertical incision for high BMI cesareans


Key clinical point: Wound complication rates were similar with Pfannenstiel and vertical incisions in women with obesity.

Major finding: At 6 weeks, 21.1% of vertical incision recipients and 18.6% of Pfannenstiel recipients had wound complications.

Study details: Randomized controlled trial of 91 women with obesity receiving cesarean section.

Disclosures: Dr. Marrs reported no conflicts of interest.

Source: Marrs CC et al. Am J Obstet Gynecol. 2018 Jan;218:S29.



No clear winner emerged in a first-ever randomized controlled trial comparing Pfannenstiel with vertical incisions for women with obesity having cesarean delivery, though enrollment difficulties limited study numbers, with almost two-thirds of eligible women declining to participate in the surgical trial.

At 6 weeks postdelivery, 21.1% of women who had a vertical incision experienced wound complications, compared with 18.6% of those who had a Pfannenstiel incision, a nonsignificant difference. This was a smaller difference than was seen at 2 weeks postpartum, when 20% of the vertical incision group had wound complications, compared with 10.4% of those who had a Pfannenstiel, also a nonsignificant difference. Maternal and fetal outcomes didn’t differ significantly with the two surgical approaches.

Dr. Carolyn Marrs

Dr. Carolyn Marrs

”We were unable to demonstrate a difference in the primary or secondary outcomes in women with class III obesity who received Pfannenstiel versus vertical skin incision,” said Caroline C. Marrs, MD, presenting the study results at the meeting sponsored by the Society for Maternal-Fetal Medicine.

Though there had been several observational studies comparing vertical with Pfannenstiel incisions for cesarean delivery in women with obesity, no randomized, controlled trials had been conducted, and observational study results were mixed, said Dr. Marrs.


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