Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery.
ABSTRACT To determine factors influencing separation and infectious type wound complications (WCs) in morbidly obese women undergoing primary cesarean delivery (CD).
Retrospective cohort study evaluating infectious and separation WC in morbidly obese (body mass index [BMI] > 35 kg/m(2)) women undergoing primary CD between January 1994 and December 2008. Chi-square, Fisher's exact and Student's t tests used to assess associated factors; backward logistic regression to determine unadjusted and adjusted odds ratios.
Of 623 women, low transverse skin incisions were performed in 588 (94.4%), vertical in 35 (7%). Overall WC rate was 13.5%, which varied by incision type (vertical 45.7% vs. 11.6% transverse; p < 0.01), but not BMI class. Incision type and unscheduled CD were associated with infection risk, while incision type, BMI, race and drain use were associated with wound separation.
In morbidly obese women both infectious and separation type WC are more common in vertical than low transverse incisions; therefore transverse should be preferred.
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ABSTRACT: Obesity is increasing worldwide, especially in the USA. This is reflected in the pregnant population, with up to a third of women classified as obese during their pregnancy. It poses a challenge to the practitioners throughout pregnancy, labor and delivery, as well as in postpartum care. Obesity is also a risk factor for multiple pregnancy complications including gestational diabetes, hypertensive disorders of pregnancy, iatrogenic preterm birth, fetal macrosomia and intrauterine fetal demise. Antenatal care challenges, including limitation of fetal ultrasound evaluation, contribute to a greater number of undetected anomalies and poor fetal weight estimation. Maternal risks such as increased rates of cesarean section, and subsequent postoperative complications such as wound infection and venous thromboembolic events, are increasing in prevalence. Optimal prenatal care requires knowledge of and attention to each of these risks and appropriate patient counseling.Expert Review of Obstetrics & Gynecology 01/2014; 7(6). DOI:10.1586/eog.12.53
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ABSTRACT: Obesity is an epidemic in the developed world. In the U.S., over one-third of women are now obese, with significant adverse consequences for their reproductive and long-term health. Many of these women gain excessive weight in pregnancy and retain it postpartum, with an additive effect across multiple pregnancies. Maternal obesity is associated with an increased risk for miscarriage, congenital anomalies, stillbirth, gestational diabetes, preeclampsia, and cesarean section. Offspring of obese women are at increased risk for being large for gestational age and may be programmed for obesity and metabolic syndrome, thus perpetuating a cycle of obesity across generations. Certain alterations to routine prenatal care may be necessary for obese women in order to optimize obstetric and neonatal outcomes. Future research priorities should be aimed at understanding the biologic mechanisms underlying the adverse outcomes associated with maternal obesity and at developing effective interventions for this growing high-risk population.03/2014; 1(1). DOI:10.1007/s40471-013-0003-z