Extreme Obesity and Postcesarean Maternal Complications

OBJECTIVE: To estimate the association of obesity and extreme obesity with maternal complications after cesarean delivery. METHODS: This was a secondary cohort analysis of a randomized controlled trial. The parent study was designed to estimate the effect of supplemental oxygen on postcesarean infectious morbidity. Because the study intervention had no effect, study groups were combined as a cohort. For this secondary analysis, the exposure was obesity, stratified as normal or overweight (body mass index BMI less than 30), obese (BMI 30-45), or extremely obese (BMI higher than 45). The primary outcome was a composite of wound infection and endometritis. Secondary outcomes included wound infection, endometritis, wound opening, hematoma or seroma, and emergency department visit. We performed unadjusted and multivariable logistic regression analyses. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. RESULTS: We included 585 women in the analysis. Eighty-five patients (14.5%) had BMIs higher than 45. Rates of black race, chronic hypertension, diabetes, and gestational diabetes increased and operative duration increased with increasing obesity severity. Obese patients were more likely to have a cesarean delivery after labor and have a vertical skin incision or classical uterine incision. After controlling for confounders, extremely obese patients had a twofold to fourfold increase in postoperative complications, including the primary infectious outcome (18.8%, adjusted OR 2.7, CI 1.2-6.1), wound infection (18.8%, adjusted OR 3.4, CI 1.4-8.0), and emergency department visit (23.1%, adjusted OR 2.2, CI 1.03-4.9). CONCLUSION: Maternal extreme obesity is associated with a considerable increase in postcesarean wound complications. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00603603. LEVEL OF EVIDENCE: II.