WOUND COMPLICATIONS FOLLOWING CESAREAN DELIVERY OF PATIENTS WITH HELLP-SYNDROME - PFANNENSTIEL VERSUS VERTICAL SKIN INCISION

Objective: We sought to determine whether vertical or Pfannenstiel ski n incision was associated with fewer hemorrhagic and postoperative wou nd complications following cesarean delivery in patients with HELLP sy ndrome. Methods: As part of an extensive retrospective analysis of med ical records for all patients with HELLP syndrome who delivered betwee n January 1, 1980 and June 30, 1993, we investigated those delivering abdominally either using a midline or Pfannenstiel skin incision and p rimary skin closure. Main Outcome Measure: The principal outcome measu re was wound complication as hematoma or dehiscence. Results: A total of 215 patients were identified; 185 patients received midline vertica l skin incisions and 30 had Pfannenstiel incisions. In the midline gro up, there were 17 wound separations (17/185, 9%) and 5 other types of wound complication (total 22/185, 12%). Significantly more wound compl ications, as wound separation, occurred in 8 of the 30 (27%) patients with Pfannenstiel incisions (p = 0.01). The only fascial dehiscence in the entire series occurred in a patient with Pfannenstiel entry. Conc lusion: In this patient series, cesarean delivery in patients with HEL LP syndrome was associated with a doubling of postoperative wound comp lications when the abdomen was opened by Pfannenstiel rather than midl ine incision.