The Association of Maternal Obesity With Fetal pH and Base Deficit at Cesarean Delivery

Edwards, Rodney K.; Cantu, Jessica; Cliver, Suzanne P.; Biggio, Joseph; Owen, John; Tita, Alan T.N.

doi:10.1097/aog.0b013e31829b1e62

Cited by 30 publications

(17 citation statements)

References 26 publications

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“…In a smaller subcohort from the Maternal-Fetal Medicine Unit Cesarean Registry, maternal obesity at the time of cesarean delivery was also associated with low neonatal cord blood pH values and increased base deficit values. 17 Edwards et al 17 examined 5,742 women and included those who delivered a live, term, nonanomalous singleton neonate by prelabor cesarean delivery under spinal anesthesia. Our results support the findings of Edwards et al and suggest that prolonged operative time may have an effect on neonatal outcomes at cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index and Operative Times at Cesarean Delivery

Girsén

Osmundson

Naqvi

et al. 2014

Obstetrics &Amp; Gynecology

105

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OBJECTIVE To examine the relationship between body mass index (BMI, kg/m2) and incision-to-delivery interval and total operative time at cesarean delivery. METHODS Women with singleton gestations undergoing uncomplicated primary and repeat cesarean deliveries were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Women were classified by BMI category at time of delivery (normal 18.5–24.9, overweight 25.0–29.9, obese 30.0–39.9, and morbidly obese 40 or greater). Incision-to-delivery interval and total operative times during cesarean delivery were compared among the three groups. Primary outcome was prolonged incision-to-delivery interval as defined by 90th percentile or greater of the study population or 18 minutes or longer. RESULTS Of the 21,372 women included in the analysis, 9,928 were obese (46.5%) and 2,988 (14.0%) were morbidly obese. Longer operative times were found among women with overweight (median [interquartile range] incision-to-delivery: 9.0 [6.0] and total operative time: 45.0 [21.0] minutes), obese (10.0 [7.0]; 48.0 [22.0] minutes), and morbidly obese BMIs (12.0 [8.0]; 55.0 [26.0] minutes) compared with women with normal BMI at delivery (9.0 [5.0]; 43.0 [20.0] minutes) (P<.001). Morbidly obese women had a more frequent incision-to-delivery interval that was 18 minutes or longer (n = 602 [20%] compared with 127 [6%] in normal BMI). After adjustments including number of prior cesarean deliveries, incision-to-delivery interval 18 minutes or longer was significantly related to obese (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.31–2.03) and morbidly obese (OR 2.81, 95% CI 2.24– 3.56) BMI at delivery. CONCLUSION Increasing BMI is related to increased incision-to-delivery interval and total operative time at cesarean delivery with morbidly obese BMI exposing women to the highest risk of prolonged incision-to-delivery interval.

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Section: Discussionmentioning

confidence: 99%

Body Mass Index and Operative Times at Cesarean Delivery

Girsén

Osmundson

Naqvi

et al. 2014

Obstetrics &Amp; Gynecology

105

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“…During pregnancy, obesity has been related to several obstetric and fetal complications, and the effect is dose-dependent [ 17 ]. On the other hand, there is only a small amount of data available about the relationship between being underweight during pregnancy and perinatal complications [ 18 ]; in fact the risk of several pregnancy, intrapartum, postnatal, and neonatal complications are less common in underweight women [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study

Kapaya

Williams

Elton

et al. 2018

Journal of Pregnancy

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Background Despite major advances in perinatal medicine, intrapartum asphyxia remains a leading and potentially preventable cause of perinatal mortality and long-term morbidity. The umbilical cord pH is considered an essential criteria for the diagnosis of acute intrapartum hypoxic events. The purpose of this study was to evaluate whether obstetric risk factors are associated with fetal acidaemia at delivery. Methodology In a case-control study, 294 women with term singleton pregnancies complicated by an umbilical artery cord pH < 7.20 at birth were individually matched by controls with umbilical artery cord pH > 7.20. Groups were compared for differences in maternal, obstetric, and fetal characteristics using logistic regression models presented as odds ratio (OR) with 95% confidence intervals (CI). Results The study showed pregestational diabetes (PGDM) [OR: 5.31, 95% CI: 1.15- 24.58, P = 0.018], urinary tract infection (UTI) [OR: 3.21, 95% CI: 1.61- 6.43, P < 0.001], and low Apgar scores to be significantly associated with acidaemia, whereas low maternal BMI [OR: 0.19, 95% CI: 0.04-0.87, P = 0.032], pyrexia in labour [OR 0.23; 95% CI 0.12-0.53; P < 0.001], electronic fetal monitoring (EFM) [OR 0.65; 95% CI 0.43-0.99; P = 0.042), and emergency caesarean section [OR 0.42; 95% CI 0.26-0.66; P < 0.001] were found to be protective of acidaemia. Conclusion Certain obstetric risk factors before and during labour can identify newborns at risk of developing acidaemia. Further research is needed to gain quantitative insight into the predictive capacity of these risks that can inform obstetric clinical management for improved outcomes.

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“…In a secondary analysis of women with term, singleton neonates undergoing a planned, unlabored cesarean delivery in the MFMU Cesarean Registry, increasing maternal BMI was associated with a decrease in mean umbilical cord arterial pH. 38 A smaller cohort from a single institution also demonstrated an increase in neonatal admission to the special care nursery or neonatal intensive care unit with increasing maternal BMI. 39 …”

Section: Impact Of Obesity On Total Operative Time and Incision-to-dementioning

confidence: 94%

Delivery of the Obese Gravida

Faucett

Metz

2016

Clinical Obstetrics &Amp; Gynecology

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Obesity in pregnancy confers morbidity to both the mother and neonate. Obese women are at increased risk of cesarean delivery, operative vaginal delivery, and failed trial of labor after cesarean delivery. In addition to impacting the mode of delivery, obesity is associated with hemorrhage, infection, and thromboembolic complications intheperipartumperiod. The risk of these complications increases with increasing maternal body mass index. In this chapter, we discuss evidence-based strategies to mitigate these risks and to manage complications that occur at the time of delivery in obese parturients.

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The Association of Maternal Obesity With Fetal pH and Base Deficit at Cesarean Delivery

Abstract: II.

Cited by 30 publications

References 26 publications

Body Mass Index and Operative Times at Cesarean Delivery

Body Mass Index and Operative Times at Cesarean Delivery

Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study

Delivery of the Obese Gravida

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