We appreciate Drs Plymel’s and Mariona’s interest in our study. Our study compared the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity who required primary cesarean delivery in the Maternal-Fetal Medicine Unit cesarean registry. Drs Plymel and Mariona consider the benefits of alternative incision types, such as the Joel-Cohen and a supraumbilical transverse incision in this patient population. The Maternal-Fetal Medicine Unit cesarean registry did not specify the exact location of the transverse incision; therefore, we could not assess this question.

We agree that a randomized clinical trial is the best way to investigate the optimal skin incision for the prevention of wound complications after cesarean delivery in women with morbid obesity. Such a randomized clinic trial is underway at our institution (NCT018997376). For reasons of feasibility and generalizability, we are comparing 2 incisions: Pfannenstiel (low transverse) and vertical. Less commonly performed incisions such as supraumbilical transverse incisions may offer some benefits and can be further investigated in the future. However, they will not be included in our initial trial.