title: Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery.
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.
  
  
  METHODS
  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/m(2) (n = 668 women), 30-39.9 kg/m(2) (n = 1002 women), 40-49.9 kg/m(2) (n = 403 women), or ≥50 kg/m(2) (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/m(2), 11.0 ± 6.8 for 30-39.9 kg/m(2), 13.0 ± 8.0 for 40-49.9 kg/m(2), and 16.0 ± 11.3 for ≥50 kg/m(2) (P < .01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m(2), 25% for 30-39.9 kg/m(2), 29.8% for 40-49.9 kg/m(2), and 32.1% for ≥50 kg/m(2) (P = .02).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Shayna N
authors.initials: SN
authors.lastname: Conner
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Longman
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D015992:Body Mass Index; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology*; D061646:Operative Time; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: cesarean delivery; incision; interval; neonatal outcome; obesity