Клінічна ефективність різних методик проведення кесаревого розтину за морбідного ожиріння

The World Obesity Federation (WOF) projects that by 2030, one billion people worldwide will be living with obesity. The WOF specifically highlights morbid obesity (MO), defined as a body mass index (BMI) of greater 40 kg/m2. Pregnant women with MO are known to be at significantly increased risk of prenatal, perinatal, and postpartum complications. In particular, MO is strongly associated with cardiometabolic disorders. It has been established that the cesarean section (CS) rate among pregnant women with BMI ≥ 50 kg/m2 approaches 50%.The objective: to evaluate the clinical effectiveness of two different CS techniques in pregnant women with MO by conducting a comparative analysis of intraoperative and postoperative complications.Materials and methods. A retrospective cohort study was conducted during 2022–2025 at the clinical bases of the Department of Obstetrics and Gynecology No. 1, Shupyk National Healthcare University of Ukraine. The study included 55 women aged 29–41 years with singleton pregnancies and diagnosed MO. Cases of CS performed using two different surgical techniques were analyzed. The participants were stratified into two groups: I group (n = 21) included pregnant women with MO who underwent supraumbilical laparotomy and fundal transverse CS; II group (n = 34) involved women with MO who underwent standard CS (via suprapubic Joel-Cohen laparotomy and lower uterine segment transverse incision). Patient history, comorbidities, pregnancy complications, indications for CS, and intra- and postoperative outcomes were analyzed. Statistical processing was carried out using MedCalc and Microsoft Excel 365. Student’s t-test was applied, and results were considered significant at p < 0.05.Results. Both groups primarily included older primiparous women, with a mean age of 32.0 ± 2.1 years, BMI > 40 kg/m2, and significant panniculus (p > 0.05). The groups were representative in extragenital pathology, predominantly cardiovascular diseases (chronic arterial hypertension – CAH) and endocrine pathology (gestational diabetes mellitus – GDM). The main indications for CS were severe combined preeclampsia on the background of CAH, diabetic fetopathy due to GDM, and fetal distress during pregnancy or labor. Compared to I group, in women in II group had significantly higher intraoperative blood loss, longer fetal extraction time and CS duration; in the postoperative period – pain intensity, hospital stay, and the incidence of complications involving the surgical wound and uterus (p < 0.05).Conclusions. Our retrospective cohort study confirmed the obvious advantages of supraumbilical laparotomy with fundal transverse CS in pregnant women with MO: optimal access to the uterine fundus and body, ease of fetal extraction, reduced blood loss, shorter CS duration, decreased postoperative pain, and lower risk of purulent-inflammatory postpartum complications. These factors contributed to faster recovery and shorter hospital stay.