810: Emergency cesarean delivery in obese women: delivery and neonatal outcomes

Abstract

women: delivery and neonatal outcomes Robert Ehsanipoor, Mathew Goldshore, Haitham Baghlaf, Janice Henderson, Irina Burd, Erika Werner The Johns Hopkins University, Gynecology and Obstetrics, The Johns Hopkins University, Bloomberg School of Public Health OBJECTIVE: To compare delivery and neonatal outcomes of morbidly obese women (BMI or 40 kg/m2) to those with a BMI of less than 40 kg/m2 undergoing emergency cesarean delivery. STUDY DESIGN: A retrospective cohort study of all singleton pregnancies undergoing emergent Cesarean delivery at an academic institution from 2004 2011. Body mass index was calculated based on the weight at delivery. Outcomes for women with a BMI of or 40 kg/m2 were compared to those with a BMI of 40 kg/m2. Women undergoing an unscheduled Cesarean delivery with an indication of non-reassuring fetal heart rate tracing, vaginal bleeding, suspected uterine rupture, or cord prolapsed were included. Women with abnormal labor progression, malpresentation, or that presented in labor prior to a scheduled Cesarean were not included unless they also had one of the above mentioned indications. The primary outcome was the time from decision to perform a Cesarean to incision. Wilcoxan rank sum test was used to evaluate continuous variables. Chi squared and logistic regression tests were used to evaluate dichotomous outcomes. RESULTS: A total 102/456 (22.4%) women had a BMI of or 40 kg/m. There were no significant differences between the groups in regard to age, parity, previous Cesarean delivery, or epidural use during labor. Morbid obesity was associated with a significantly greater median decision to incision time (41 vs 30.5 mins; p 0.04), length of surgery (71 vs 58.5 mins; 0.01), and estimated blood loss (900 vs 800 ml; p 0.01). There was not a significant difference in the need for general anesthesia (OR 1.7; 95% CI 0.9-3.3), or NICU admission (OR 1.3; 95% CI 0.8-2.1). CONCLUSION: Emergency Cesarean delivery in morbidly obese women is associated with longer decision to incision intervals, length of surgery, and a greater blood loss. These factors need to be considered when counseling and managing morbidly obese women.