title: The effect of maternal obesity on outcomes in patients undergoing tertiary or higher cesarean delivery.
abstract: OBJECTIVE
  To estimate the association between maternal obesity and adverse outcomes in patients without placenta previa or accreta undergoing a tertiary or higher cesarean delivery.
  
  
  METHODS
  Retrospective cohort of patients cared for by a single MFM practice undergoing a tertiary or higher cesarean delivery from 2005 to 2013. Patients attempting vaginal delivery and patients with placenta accreta and/or placenta previa were excluded. We estimated the association of maternal obesity (prepregnancy BMI ≥ 30 kg/m(2)) and maternal outcomes. The primary outcome was a composite of severe maternal morbidity (uterine rupture, hysterectomy, blood transfusion, cystotomy requiring repair, bowel injury requiring repair, intensive care unit admission, thrombosis, re-operation, or maternal death).
  
  
  RESULTS
  Three hundred and forty four patients met inclusion criteria, 73 (21.2%) of whom were obese. The composite outcome was significantly higher in the obese group (6.8% versus 1.8%, p = 0.024, aOR 4.36, 95% CI 1.21, 15.75). The incidence of several individual adverse outcomes were also increased in obese women, including blood transfusion (4.1% versus 0.7%, p = 0.033, aOR 7.36, 95% CI 1.19, 45.34), wound separation or infection (20.5% versus 5.9%, p < 0.001, aOR 4.05, 95% CI 1.75, 9.36) and 1-min Apgar score less than 7 (6.8% versus 1.9%, p = 0.024, aOR 4.40, 95% CI 1.21, 15.94).
  
  
  CONCLUSIONS
  In patients undergoing a tertiary or higher cesarean delivery without placenta previa or accreta, obesity increases the risk of adverse outcomes. Obese patients are at risk for blood transfusion, low 1-min Apgar scores and postoperative wound complications.
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York, NY , USA and.
authors: Mirella
authors: M
authors: Mourad
authors: Michael
authors: M
authors: Silverstein
authors: Samuel
authors: S
authors: Bender
authors: Stephanie
authors: S
authors: Melka
authors: Chad K
authors: CK
authors: Klauser
authors: Simi
authors: S
authors: Gupta
authors: Daniel H
authors: DH
authors: Saltzman
authors: Andrei
authors: A
authors: Rebarber
authors: Nathan S
authors: NS
authors: Fox
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D012086:Reoperation; D012189:Retrospective Studies
keywords: Body mass index; cesarean; morbidity; obesity; outcomes