Traxi Panniculus Retractor for Cesarean Delivery

This prospective, open-label, randomized-controlled trial is designed to evaluate the use of the Traxi panniculus retractor-- a commercially available Class I FDA-exempt device will improve surgical outcomes, cardiopulmonary function, and provider/patient satisfaction in morbidly obese women undergoing cesarean delivery.

Morbidly obese women (BMI >/= 40) undergoing non-emergent cesarean delivery will be recruited and randomized to Traxi panniculus retraction or standard of care for panniculus retraction. The primary outcome evaluated will be operating time (incision to closure). Other secondary outcomes related to surgery including estimated blood loss, surgical site infection, and number of scrubbed personnel. A secondary aim of the study is to evaluate the hypothesis that the Traxi retraction device reduces chestwall compression panniculus retraction and will improve intraoperative pulmonary function. To do this, the investigators will measure the difference in individual participant pulmonary function tests (forced vital capacity, forced expiratory volume) before and after panniculus retraction using a bedside spirometer. A tertiary aim of the study is to evaluate the hypothesis that the Traxi retraction device will improve patient and provider satisfaction due to improved delivery experience and maintaining patient dignity. Patient and provider-reported outcomes will be evaluated using surveys.

The method of panniculus retraction will be the Traxi panniculus retraction (Clinical Innovations, LLC) by the provider.

Standard methods of panniculus retraction as determined by individual provider (including medical taping, extra personnel for retraction)

class I, FDA-exempt, commercially available for use in panniculus retraction during cesarean delivery or other laparotomy

measure difference in pulmonary function tests (FVC=forced vital capacity) before and after application of panniculus retraction method

measure difference in pulmonary function tests (FEV1=forced expiratory volume in 1 minute) before and after application of panniculus retraction method

patient-reported outcomes regarding surgery and delivery will be obtained using a survey made by the research team with a four level likert scale

provider-reported outcomes regarding surgery will be obtained using survey with an eleven level likert scale

Inclusion Criteria: Pregnant BMI greater than or equal to 40 kg/m^2 Undergoing non-emergent cesarean delivery Able and willing to provide written, informed consent Singleton gestation Exclusion Criteria: Fetal demise Disruption of abdominal skin (infection, rash, abrasion, laceration) Known adhesive allergy