Cesarean delivery complications in women with morbid obesity

Abstract

Objective: To compare cesarean complication rates between women with body mass index (BMI) 40–49.9 kg/m² and BMI ≥ 50 kg/m² and associations with surgical techniques.

Methods: This retrospective cohort study from 2009 to 2014 included women who underwent cesarean with delivery BMI ≥ 50 and an equal number with BMI 40–49.9. Wound infections and/or separations were compared. We also examined wound complication rates between skin closure techniques and self-retaining retractor use.

Results: Among 498 patients (249 with BMI ≥ 50 and 249 with BMI 40–49.9) there were no differences in estimated blood loss >1000 mL, blood transfusion, deep vein thrombosis or endometritis. Among those with outpatient follow-up (144 with BMI ≥ 50 and 162 with BMI 40–49.9), those with BMI ≥ 50 had a significantly higher rate of wound separations (p = 0.01) but not infections. There were no differences in wound complication rates between skin closure techniques or self-retaining retractor use, though the study was not powered for these comparisons.

Conclusion: Wound complications, particularly separations, increase with BMI ≥ 50 compared to a lesser degree of morbid obesity. Skin closure techniques and self-retaining retractor use were not associated with cesarean wound complications in patients with morbid obesity.

• Body mass index
• cesarean section
• delivery
• morbid
• obesity
• obstetric
• pregnancy
• surgical stapling
• sutures

Acknowledgements

The authors would like to thank Patricia McKenzie, APRN, of the Waianae Coast Comprehensive Health Center.

Declaration of interest

The authors report no conflicts of interest.

No funding source was utilized in this study.