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Operative Obstetrics

Poster Session 3

(680) Impact of obesity class on unscheduled cesarean delivery outcomes

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Obesity is a known risk factor for unplanned cesarean delivery (CD). In patients with obesity, perceived technical and surgical difficulty may influence decision-making on when to perform the CD. We sought to evaluate the impact of class of obesity on unscheduled CD outcomes.

Study Design: This is a retrospective cohort study of all singleton, non-anomalous gestations delivered by unscheduled CD at a tertiary care center from 2018-2021. The primary outcome was time from skin incision to delivery. Secondary outcomes were composite measures of maternal (postpartum hemorrhage, transfusion, endomyometritis, ICU admission, readmission, wound complication requiring a hospital encounter, or bowel/bladder injury) and neonatal (NICU admission, respiratory support, therapeutic hypothermia, fetal acidemia) morbidity. We stratified patients according to obesity class (class I, class II, and class III at time of CD) and compared outcomes to non-obese patients. Multivariate logistic regression was used to control for potential confounders.

Results: Of 1856 unscheduled CD, 569 (30.1%) were performed in non-obese patients and 452 (24.4%), 347 (18.7%), and 488 (26.3%) were in patients with class I, II, and III obesity, respectively. Operative times to delivery were significantly longer in patients with obesity (6 [IQR 3-9] min. in non-obese vs 7 [IQR 4-10], 8 [IQR 4-11], and 9 [IQR 5-12] min (p< 0.001). in patients with class I, II and II obesity respectively). Patients with Class I and II obesity had similar rates of composite maternal morbidity as non-obese patients. Patients with Class III obesity had a significantly increased risk of maternal morbidity compared to non-obese patients.  (40.4 vs. 31.8%, aRR 1.19 95%CI 1.01-1.38.) Class of obesity was not significantly associated with neonatal morbidity.

Conclusion: Although maternal obesity was associated with longer operative times during unscheduled CD, the absolute difference in incision to delivery time of 1-2 minutes is unlikely to be clinically impactful as neonatal outcomes are similar. Maternal morbidity is only increased in patients with class III obesity.