Complications of cesarean delivery in the massively obese parturient

• Published in: American journal of obstetrics and gynecology Vol. 203; no. 3; pp. 271.e1 - 271.e7
• Main Authors: Alanis, Mark C., MD, MSCR, Villers, Margaret S., MD, MSCR, Law, Tameeka L., MD, MSCR, Steadman, Elizabeth M., BS, Robinson, Christopher J., MD, MSCR
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2010; Elsevier
• Subjects: Biological and medical sciences; Blood Loss, Surgical - statistics & numerical data; Body Mass Index; cesarean delivery; Cesarean Section - adverse effects; Cesarean Section - methods; Diabetes Complications; Drainage - adverse effects; Female; Gynecology. Andrology. Obstetrics; Humans; Maternal Age; Medical sciences; Metabolic diseases; Obesity; Obesity, Morbid - complications; Obstetrics and Gynecology; Patient Readmission - statistics & numerical data; Pregnancy; Reoperation - statistics & numerical data; Retrospective Studies; Smoking - adverse effects; superobesity; Surgical Wound Infection - etiology; wound complication; Wound Healing; wound infection; wound complication; wound infection; cesarean delivery; superobesity; obesity; Obstetrical technique; Obesity; Treatment; Surgery; Gynecology; Nutrition disorder; Complication; Obstetrics; Cesarean section; Nutritional status
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2010.06.049

Objective The objective of the study was to determine predictors of cesarean delivery morbidity associated with massive obesity. Study Design This was an institutional review board–approved retrospective study of massively obese women (body mass index, ≥50 kg/m2 ) undergoing cesarean delivery. Bivariable and multivariable analyses were used to assess the strength of association between wound complication and various predictors. Results Fifty-eight of 194 patients (30%) had a wound complication. Most (90%) were wound disruptions, and 86% were diagnosed after hospital discharge (median postoperative day, 8.5; interquartile range, 6–12). Subcutaneous drains and smoking, but not labor or ruptured membranes, were independently associated with wound complication after controlling for various confounders. Vertical abdominal incisions were associated with increased operative time, blood loss, and vertical hysterotomy. Conclusion Women with a body mass index ≥50 kg/m2 have a much greater risk for cesarean wound complications than previously reported. Avoidance of subcutaneous drains and increased use of transverse abdominal wall incisions should be considered in massively obese parturients to reduce operative morbidity.