Obesity's Impact on Incision to Delivery Interval and Neonatal Outcomes at Time of Urgent Cesarean

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

1-29-2021

DOI

10.1016/j.ajog.2020.12.849

Journal Title

American Journal of Obstetrics and Gynecology

Department

Obstetrics and Gynecology

Second Department

Anesthesiology

Abstract

Objective

To determine if increased body mass index (BMI) impacts incision to delivery interval, in the setting of category II and III fetal heart-rate tracing, necessitating emergent cesarean delivery.

Study Design

A retrospective cohort study of all emergent cesarean deliveries occurring at one institution from 2012-2018. Three comparison groups were divided by BMI /=35 kg/cm2 (n=51). The primary outcome was time from operating room and skin incision to infant delivery. Secondary outcomes were a measure of neonatal morbidity: 5-minute Apgar score less than 7, umbilical cord arterial pH, and NICU admission.

Results

There was a statistically significant difference in the length of time from arrival in the operating room to delivery and from incision to delivery for patients with higher BMI (p=0.037 and 0.025). There were also higher rates of fetal acidosis in fetuses born to moms with a higher BMI (p=0.047). these findings were consistent when controlling for number of prior laparotomies and when excluding patients who received general anesthesia.

Conclusion

These findings support prior literature that describe a longer incision to delivery interval in patients undergoing cesarean delivery, as well as worse neonatal outcomes in patients with a larger BMI. Our study is unique in the sense that it describes this challenge in the context of urgent cesarean deliveries. We advise the Obstetrician to consider these findings when patients with large BMI have fetal heart rate tracings that do not respond to initial resuscitative efforts.

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