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374: Association between maternal obesity and major intraoperative complications
Poster Session II
ajog.org 374 Association between maternal obesity and major intraoperative complications Marcela Carolina Smid1, Catherine J. Vladutiu1, Sarah K. Dotters-Katz1, Tracy A. Manuck1, David M. Stamilio1 1
University of North Carolina - Chapel Hill, Chapel Hill, NC
OBJECTIVE: Studies have shown an association between maternal obesity
373 Clinical management of stillbirth Annelee Boyle1, Jessica P. Preslar2,3, Carol J. Hogue2,3, Robert M. Silver4, Uma M. Reddy5, Robert L. Goldenberg6, Donald J. Dudley1, SCRN Investigators5 1
University of Virgina School of Medicine, Charlottesville, VA, 2Emory University School of Medicine, Atlanta, GA, 3Emory University School of Public Health, Atlanta, GA, 4University of Utah School of Medicine, Salt Lake City, UT, 5Eunice Kennedy Shriver NICHD, Bethesda, MD, 6Columbia University Medical Center, New York, NY
OBJECTIVE: To describe delivery management of singleton stillbirth in a large population-based, multicenter, prospective cohort. STUDY DESIGN: We conducted a retrospective study of 611 women with singleton stillbirth at 20 weeks of gestation enrolled in the Stillbirth Collaborative Research Network from March 2006 to September 2008. The study was conducted at 59 hospitals in 5 geographically defined catchment areas to ensure access to at least 90% of all deliveries. Medical and delivery information were abstracted from the medical record. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery (CD). Indications for CD were classified as obstetric (abnormal fetal heart tracing, abruption, coagulopathy, uterine rupture, placenta previa or dystocia) or non-obstetric (patient request, repeat cesarean delivery, or not stated). RESULTS: Of the 611 total cases of stillbirth, 93 (15.2%) experienced CD. The primary CD rate was 9.3% (47/504); the repeat CD rate was 43.0% (46/107). Among women who underwent primary CD, 38.3% (18/47) had no obstetric indication. Among women who underwent repeat CD, 78.3% (36/46) had no obstetric indication. Their most common indication was repeat procedure. Of 326 women without previous CD who underwent induction, 321 (98.5%) delivered vaginally. Among women with a history of previous CD who underwent induction, 91.1% (41/45) delivered vaginally with 2 cases of uterine rupture. Of 143 women without previous CD who presented in labor, 136 (95.1%) delivered vaginally. Among women with a history of previous CD who presented in labor, 74.1% (20/27) delivered vaginally with no uterine rupture. CONCLUSION: Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced, or whether they had had a previous CD. CD was utilized more often than expected in women with stillbirth, often without a clear obstetric indication. Provider education regarding the optimal route of delivery for women with stillbirth and further research regarding physician and patient attitudes towards delivery with stillbirth are warranted.
and post-operative complications, but there is a dearth of information about obesity and intra-operative complications. We sought to estimate the association between maternal obesity at delivery and major intraoperative cesarean delivery (CD) complications. STUDY DESIGN: A secondary retrospective cohort analysis of the MFMU Cesarean Registry. Maternal BMI at delivery was categorized as nonobese (BMI 18.5-29.9), non-Class III obesity (BMI 30-39.9) and Class III obesity (BMI 40). A subgroup analysis was conducted for Class III obese women with BMI 40-49.9, 50-59.9, and 60. The primary outcome was defined as having at least one major intraoperative complication, including blood transfusion, intra-operative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, laparotomy, and hysterectomy. Secondary analyses assessed each complication separately, and maternal death. Logistic regression was performed and models were adjusted for age, race, number of prior CD, CD after labor, birth weight, hemoglobin, cesarean indication, anesthesia, uterine and skin incision. RESULTS: 51,264 women underwent CD; 38% were non-obese, 47% were non-Class III obese and 15% were Class III obese. Among Class III obese women, 82% (n¼6329) had BMI 40-49.9; 15% (n¼1131) had BMI 50-59.9, and 3% (n¼227) had BMI 60. Compared to nonobese women, non-Class III obese women had lower odds of operative injury and Class III obese women had lower odds of having at least one severe intraoperative complication, transfusion, and intra-operative injury, adjusting for confounders (Table). In subgroup analyses, class III obese women with BMI 40-49.9 had lower odds of having at least one severe intraoperative complication (OR 0.76, 95% CI 0.63, 0.91), operative injury (OR 0.52, 95% CI 0.32-0.84) and transfusion (OR 0.72, CI 0.57, 0.90) compared to non-obese women. CONCLUSION: In contrast to studies on post-operative complications, the risk of intra-operative cesarean complications appears to be lower in obese compared to non-obese patients. This finding was most pronounced among the most severely obese patients. Major intraoperative complications and maternal BMI Non-obese Non-Class III obese Class III obese Non-Class III obesityvs. Non-obese Class III obesity vs. Non-obese n (%)
n (%)
OR (95% CI)
OR (95% CI)
N=19,527
N=24,004
N=7687
Composite
739 (3.8)
757 (3.2)
224 (2.9)
n (%)
0.95 (0.84, 1.06)
0.83 (0.70, 0.98)
Transfusion
537 (2.8)
523 (2.2)
148 (1.9)
0.95 (0.83, 1.09)
0.80 (0.65, 0.98)
Atony
156 (0.8)
205 (0.9)
62 (0.8)
1.15 (0.92, 1.45)
1.07 (0.77, 1.47)
Operative Injury 127 (0.7)
102 (0.4)
30 (0.4)
0.67 (0.50, 0.88)
0.51 (0.33, 0.80)
Laparotomy
57 (0.2)
25 (0.3)
1.12 (0.73, 1.73)
1.29 (0.75, 2.24)
Hysterectomy
110 (0.6)
131 (0.6)
37 (0.5)
1.12 (0.84,1.49)
0.84 (0.54, 1.28)
Death
46 (0.2)
15 (0.08)
6 (0.02)
7 (0.09)
0.39 (0.14, 1.09)
1.21 (0.4, 3.28)
375 Adverse perinatal outcomes and vertical HIV transmission among women with history of low birth weight infant in Lusaka, Zambia Marcela Carolina Smid1, Bellington Vwalika2, Marie CD. Stoner1, Yusef Ahmed2, Benjamin H. Chi1, Jeffrey SA. Stringer1, Elizabeth M. Stringer1 1 University of North Carolina - Chapel Hill, Chapel Hill, NC, 2University of Zambia, University Teaching Hospital, Lusaka, Zambia
OBJECTIVE: To determine adverse perinatal outcomes and vertical
HIV transmission among women with prior history of low birth weight (LBW) (<2500 g) in an urban African obstetric population.
S208 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org 374 Association between maternal obesity and major intraoperative complications Marcela Carolina Smid1, Catherine J. Vladutiu1, Sarah K. Dotters-Katz1, Tracy A. Manuck1, David M. Stamilio1 1
University of North Carolina - Chapel Hill, Chapel Hill, NC
OBJECTIVE: Studies have shown an association between maternal obesity
373 Clinical management of stillbirth Annelee Boyle1, Jessica P. Preslar2,3, Carol J. Hogue2,3, Robert M. Silver4, Uma M. Reddy5, Robert L. Goldenberg6, Donald J. Dudley1, SCRN Investigators5 1
University of Virgina School of Medicine, Charlottesville, VA, 2Emory University School of Medicine, Atlanta, GA, 3Emory University School of Public Health, Atlanta, GA, 4University of Utah School of Medicine, Salt Lake City, UT, 5Eunice Kennedy Shriver NICHD, Bethesda, MD, 6Columbia University Medical Center, New York, NY
OBJECTIVE: To describe delivery management of singleton stillbirth in a large population-based, multicenter, prospective cohort. STUDY DESIGN: We conducted a retrospective study of 611 women with singleton stillbirth at 20 weeks of gestation enrolled in the Stillbirth Collaborative Research Network from March 2006 to September 2008. The study was conducted at 59 hospitals in 5 geographically defined catchment areas to ensure access to at least 90% of all deliveries. Medical and delivery information were abstracted from the medical record. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery (CD). Indications for CD were classified as obstetric (abnormal fetal heart tracing, abruption, coagulopathy, uterine rupture, placenta previa or dystocia) or non-obstetric (patient request, repeat cesarean delivery, or not stated). RESULTS: Of the 611 total cases of stillbirth, 93 (15.2%) experienced CD. The primary CD rate was 9.3% (47/504); the repeat CD rate was 43.0% (46/107). Among women who underwent primary CD, 38.3% (18/47) had no obstetric indication. Among women who underwent repeat CD, 78.3% (36/46) had no obstetric indication. Their most common indication was repeat procedure. Of 326 women without previous CD who underwent induction, 321 (98.5%) delivered vaginally. Among women with a history of previous CD who underwent induction, 91.1% (41/45) delivered vaginally with 2 cases of uterine rupture. Of 143 women without previous CD who presented in labor, 136 (95.1%) delivered vaginally. Among women with a history of previous CD who presented in labor, 74.1% (20/27) delivered vaginally with no uterine rupture. CONCLUSION: Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced, or whether they had had a previous CD. CD was utilized more often than expected in women with stillbirth, often without a clear obstetric indication. Provider education regarding the optimal route of delivery for women with stillbirth and further research regarding physician and patient attitudes towards delivery with stillbirth are warranted.
and post-operative complications, but there is a dearth of information about obesity and intra-operative complications. We sought to estimate the association between maternal obesity at delivery and major intraoperative cesarean delivery (CD) complications. STUDY DESIGN: A secondary retrospective cohort analysis of the MFMU Cesarean Registry. Maternal BMI at delivery was categorized as nonobese (BMI 18.5-29.9), non-Class III obesity (BMI 30-39.9) and Class III obesity (BMI 40). A subgroup analysis was conducted for Class III obese women with BMI 40-49.9, 50-59.9, and 60. The primary outcome was defined as having at least one major intraoperative complication, including blood transfusion, intra-operative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, laparotomy, and hysterectomy. Secondary analyses assessed each complication separately, and maternal death. Logistic regression was performed and models were adjusted for age, race, number of prior CD, CD after labor, birth weight, hemoglobin, cesarean indication, anesthesia, uterine and skin incision. RESULTS: 51,264 women underwent CD; 38% were non-obese, 47% were non-Class III obese and 15% were Class III obese. Among Class III obese women, 82% (n¼6329) had BMI 40-49.9; 15% (n¼1131) had BMI 50-59.9, and 3% (n¼227) had BMI 60. Compared to nonobese women, non-Class III obese women had lower odds of operative injury and Class III obese women had lower odds of having at least one severe intraoperative complication, transfusion, and intra-operative injury, adjusting for confounders (Table). In subgroup analyses, class III obese women with BMI 40-49.9 had lower odds of having at least one severe intraoperative complication (OR 0.76, 95% CI 0.63, 0.91), operative injury (OR 0.52, 95% CI 0.32-0.84) and transfusion (OR 0.72, CI 0.57, 0.90) compared to non-obese women. CONCLUSION: In contrast to studies on post-operative complications, the risk of intra-operative cesarean complications appears to be lower in obese compared to non-obese patients. This finding was most pronounced among the most severely obese patients. Major intraoperative complications and maternal BMI Non-obese Non-Class III obese Class III obese Non-Class III obesityvs. Non-obese Class III obesity vs. Non-obese n (%)
n (%)
OR (95% CI)
OR (95% CI)
N=19,527
N=24,004
N=7687
Composite
739 (3.8)
757 (3.2)
224 (2.9)
n (%)
0.95 (0.84, 1.06)
0.83 (0.70, 0.98)
Transfusion
537 (2.8)
523 (2.2)
148 (1.9)
0.95 (0.83, 1.09)
0.80 (0.65, 0.98)
Atony
156 (0.8)
205 (0.9)
62 (0.8)
1.15 (0.92, 1.45)
1.07 (0.77, 1.47)
Operative Injury 127 (0.7)
102 (0.4)
30 (0.4)
0.67 (0.50, 0.88)
0.51 (0.33, 0.80)
Laparotomy
57 (0.2)
25 (0.3)
1.12 (0.73, 1.73)
1.29 (0.75, 2.24)
Hysterectomy
110 (0.6)
131 (0.6)
37 (0.5)
1.12 (0.84,1.49)
0.84 (0.54, 1.28)
Death
46 (0.2)
15 (0.08)
6 (0.02)
7 (0.09)
0.39 (0.14, 1.09)
1.21 (0.4, 3.28)
375 Adverse perinatal outcomes and vertical HIV transmission among women with history of low birth weight infant in Lusaka, Zambia Marcela Carolina Smid1, Bellington Vwalika2, Marie CD. Stoner1, Yusef Ahmed2, Benjamin H. Chi1, Jeffrey SA. Stringer1, Elizabeth M. Stringer1 1 University of North Carolina - Chapel Hill, Chapel Hill, NC, 2University of Zambia, University Teaching Hospital, Lusaka, Zambia
OBJECTIVE: To determine adverse perinatal outcomes and vertical
HIV transmission among women with prior history of low birth weight (LBW) (<2500 g) in an urban African obstetric population.
S208 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016