title: Complications of cesarean delivery in the massively obese parturient.
abstract: OBJECTIVE
  The objective of the study was to determine predictors of cesarean delivery morbidity associated with massive obesity.
  
  
  METHODS
  This was an institutional review board-approved retrospective study of massively obese women (body mass index, > or = 50 kg/m(2)) undergoing cesarean delivery. Bivariable and multivariable analyses were used to assess the strength of association between wound complication and various predictors.
  
  
  RESULTS
  Fifty-eight of 194 patients (30%) had a wound complication. Most (90%) were wound disruptions, and 86% were diagnosed after hospital discharge (median postoperative day, 8.5; interquartile range, 6-12). Subcutaneous drains and smoking, but not labor or ruptured membranes, were independently associated with wound complication after controlling for various confounders. Vertical abdominal incisions were associated with increased operative time, blood loss, and vertical hysterotomy.
  
  
  CONCLUSIONS
  Women with a body mass index > or = 50 kg/m(2) have a much greater risk for cesarean wound complications than previously reported. Avoidance of subcutaneous drains and increased use of transverse abdominal wall incisions should be considered in massively obese parturients to reduce operative morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Alanis
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Villers
authors.forename: Tameeka L
authors.initials: TL
authors.lastname: Law
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Steadman
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Robinson
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D048909:Diabetes Complications; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008423:Maternal Age; D009767:Obesity, Morbid / Q000150:complications*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011247:Pregnancy; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology*; D014945:Wound Healing