The utility of midtrimester ultrasound assessment of the subcutaneous space in predicting cesarean wound complications

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 28; no. 15; pp. 1766 - 1769
• Main Authors: Shainker, Scott A., Raghuraman, Nandini, Modest, Anna M., Schnettler, William T., Hacker, Michele R., Ralston, Steven J.
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 13-10-2015
• Subjects: Abdomen - diagnostic imaging; Abdominal wall thickness; Adult; Case-Control Studies; Cesarean Section - adverse effects; cesarean wound complication; Female; Humans; Incidence; Postoperative Complications - epidemiology; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Second; second trimester ultrasound; Subcutaneous Tissue - diagnostic imaging; Surgical Wound Dehiscence - epidemiology; Surgical Wound Infection - epidemiology; Sutures - statistics & numerical data; Ultrasonography, Prenatal; ultrasound prediction; wound risk factors; Young Adult; ultrasound prediction; cesarean wound complication; wound risk factors; Abdominal wall thickness; second trimester ultrasound
• ISSN: 1476-7058; 1476-4954
• DOI: 10.3109/14767058.2014.971744

Objective: To evaluate the association between cesarean wound complications and thickness of the subcutaneous space within the anterior abdomen at the midtrimester fetal anatomical survey.
Methods: In this case-control study, cases were identified using an ICD9 code for wound complications of cesarean delivery. For each case, we identified the woman with the next consecutive midtrimester ultrasound who had a cesarean delivery without a wound complication, matched on age and race, as the control. A blinded investigator measured subcutaneous space at three distinct suprapubic levels in the midsagital plane.
Results: Of 7228 women with a cesarean delivery, 123 (1.7%) had a wound complication. Seventy-nine cases were eligible. Midline suprapubic subcutaneous thickness did not differ between cases and controls at the superior, middle or inferior locations (p ≥ 0.35). Body mass index was moderately correlated with ultrasound-derived measurements (r ≥ 0.63; p < 0.001). The incidence of vertical skin incision, stapled skin closure and classical hysterotomy differed between groups (p ≤ 0.046). There was no significant increase in wound complication risk with increasing subcutaneous space thickness, even after adjustment (p ≥ 0.34).
Conclusion: Prenatal ultrasound can quantify the subcutaneous space. Vertical skin incision, stapled wound closure, and a classical hysterotomy were associated with cesarean wound complication, but midtrimester subcutaneous thickness was not.