TY - JOUR
T1 - Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery
AU - Conner, Shayna N.
AU - Tuuli, Methodius G.
AU - Longman, Ryan E.
AU - Odibo, Anthony O.
AU - Macones, George A.
AU - Cahill, Alison G.
N1 - Funding Information:
Supported in part by Robert Wood Johnson Physician Faculty Scholarship (A.G.C.) by National Institute of Child Health and Human Development T32 grant number 22-3125-77026E and Washington University Institute of Clinical and Translational Sciences grant number UL1TR000448 (S.N.C.).
PY - 2013/10
Y1 - 2013/10
N2 - Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m2, 25% for 30-39.9 kg/m2, 29.8% for 40-49.9 kg/m2, and 32.1% for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.
AB - Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m2, 25% for 30-39.9 kg/m2, 29.8% for 40-49.9 kg/m2, and 32.1% for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.
KW - cesarean delivery incision interval neonatal outcome obesity
UR - http://www.scopus.com/inward/record.url?scp=84884675961&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2013.05.054
DO - 10.1016/j.ajog.2013.05.054
M3 - Article
C2 - 23727523
AN - SCOPUS:84884675961
SN - 0002-9378
VL - 209
SP - 386.e1-386.e6
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 4
ER -