Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery

Shayna N. Conner, Methodius G. Tuuli, Ryan E Longman, Anthony O. Odibo, George A. Macones, Alison G. Cahill

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m2, 25% for 30-39.9 kg/m2, 29.8% for 40-49.9 kg/m2, and 32.1% for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume209
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

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Body Mass Index
Obesity
Skin
Morbidity
Umbilical Cord
Apgar Score
Nurseries
Neonatal Intensive Care Units
Cohort Studies
Retrospective Studies

Keywords

  • cesarean delivery incision interval neonatal outcome obesity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery. / Conner, Shayna N.; Tuuli, Methodius G.; Longman, Ryan E; Odibo, Anthony O.; Macones, George A.; Cahill, Alison G.

In: American Journal of Obstetrics and Gynecology, Vol. 209, No. 4, 10.2013.

Research output: Contribution to journalArticle

Conner, Shayna N. ; Tuuli, Methodius G. ; Longman, Ryan E ; Odibo, Anthony O. ; Macones, George A. ; Cahill, Alison G. / Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery. In: American Journal of Obstetrics and Gynecology. 2013 ; Vol. 209, No. 4.
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abstract = "Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0{\%} for <30 kg/m2, 25{\%} for 30-39.9 kg/m2, 29.8{\%} for 40-49.9 kg/m2, and 32.1{\%} for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.",
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AU - Conner, Shayna N.

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AU - Macones, George A.

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N2 - Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m2, 25% for 30-39.9 kg/m2, 29.8% for 40-49.9 kg/m2, and 32.1% for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.

AB - Objective The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study Design We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m2 (n = 668 women), 30-39.9 kg/m2 (n = 1002 women), 40-49.9 kg/m2 (n = 403 women), or ≥50 kg/m2 (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m2, 11.0 ± 6.8 for 30-39.9 kg/m2, 13.0 ± 8.0 for 40-49.9 kg/m2, and 16.0 ± 11.3 for ≥50 kg/m2 (P <.01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m2, 25% for 30-39.9 kg/m2, 29.8% for 40-49.9 kg/m2, and 32.1% for ≥50 kg/m2 (P =.02). Conclusion Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.

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