Is Incision to Delivery Time Associated With Poor Neonatal Neurological Outcomes in Women With Class 3 Obesity? [31L

Abstract

INTRODUCTION: Morbid obesity has been associated with adverse neonatal outcome. We sought to determine factors associated with adverse outcome, specifically whether incision to delivery time (IDT) was an independent risk factor for poor neonatal outcome in a morbidly obese patient. METHODS: Secondary analysis of the MFMU Cesarean Registry. Inclusion criteria were singleton pregnancy, >37 weeks EGA and BMI >40 undergoing cesarean section. Patients were stratified into 2 groups: cesarean for fetal (fetal CS) and non-fetal (non-fetal CS) indications. The primary outcome was a neonatal composite of seizure, CPR <24 hrs, death, ventilatory support >2 d, HIE, pH <7.1 and APGAR 5 <5. Multivariate logistic regression was performed to assess impact of IDT and additional risk factors. RESULTS: The primary outcome was observed in 543 and 106 neonates (total n=6325) in the non-fetal CS and fetal CS subgroups respectively. Median IDT was 14.1 m for the non-fetal CS and 7.7 m for the fetal CS respectively. Women with poor neonatal outcome were more likely to be black race, affected by hypertensive diseases of pregnancy, higher BMI, have attempted labor, and have failed a VBAC attempt (Table 1). In the regression model, IDT>90th was not associated with adverse outcomes in the non-fetal CS group and was significantly associated with normal outcomes in the fetal CS group (Table 2). CONCLUSION: In the non-fetal CS subgroup, IDT >90th percentile was not associated with adverse outcomes. In the fetal CS subgroup, women with IDT >90th percentile were not associated with an increased risk of morbidity. Black race was associated with poor outcomes in both subgroups.