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

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?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.