Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC.
Am J Obstet Gynecol. 2017 Jun;216(6):614.e1-614.e7. doi: 10.1016/j.ajog.2017.02.011. Epub 2017 Feb 14.
Multiple studies have demonstrated an association between maternal obesity and postoperative complications, but there is a dearth of information about the impact of obesity on intraoperative complications.
To estimate the association between maternal obesity at delivery and major intraoperative complications during cesarean delivery (CD).
This is a secondary analysis of the deidentified Maternal-Fetal Medicine Unit Cesarean Registry of women with singleton pregnancies. Maternal body mass index (BMI) at delivery was categorized as BMI 18.5 to 29.9 kg/m, BMI 30 to 39.9 kg/m, BMI 40 to 49.9 kg/m, and BMI ≥ 50 kg/m. The primary outcome, any intraoperative complication, was defined as having at least 1 major intraoperative complication, including perioperative blood transfusion, intraoperative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, repeat laparotomy, and hysterectomy. Log-binomial models were used to estimate risk ratios of intraoperative complication in 2 models: model 1 adjusting for maternal race, and preterm delivery <37 weeks; and model 2 adjusting for confounders in Model 1 as well as emergency CD, and type of skin incision.
A total of 51,218 women underwent CD; 38% had BMI 18.5 to 29.9 kg/m, 47% BMI 30 to 39.9 kg/m, 12% BMI 40 to 49.9 kg/m and 3% BMI ≥ 50 kg/m. Having at least 1 intraoperative complication was uncommon (3.4%): 3.8% for BMI 18.5 to 29.9 kg/m, 3.2% BMI 30 to 39.9 kg/m, 2.6% BMI 40 to 49.9 kg/m and 4.3% BMI ≥ 50 kg/m (P < .001). In the fully adjusted model 2, women with BMI 40 to 49.9 kg/m had a lower risk of any intraoperative complication (adjusted risk ratio [ARR], 0.76; 95% confidence interval [CI], 0.64 to 0.89) compared with women with BMI 18.5 to 29.9 kg/m. Women with BMI 30 to 39.9 kg/m (ARR, 0.93; 95% CI, 0.84 to 1.03) had a similar risk of any intraoperative complication compared with nonobese women. Among super obese women, there was evidence of effect modification by emergency CD. Compared with nonobese women, neither super obese women undergoing nonemergency CD (ARR, 1.13; 95% CI, 0.84 to 1.52) nor those undergoing emergency CD (ARR, 0.59; 95% CI, 0.32 to 1.10) had an increased risk of intraoperative complication.
In contrast to the risk for postcesarean complications, the risk of intraoperative complication does not appear to be increased in obese women, even among those with super obesity.
多项研究表明，产妇肥胖与术后并发症之间存在关联，但关于肥胖对剖宫产术中并发症影响的信息却很少。
评估产妇分娩时肥胖与剖宫产术中主要并发症之间的关系。
这是对具有单胎妊娠的产妇胎儿医学单位剖宫产登记处的匿名数据进行的二次分析。产妇分娩时的体重指数（BMI）分为以下几类：18.5 至 29.9kg/m²、30 至 39.9kg/m²、40 至 49.9kg/m²和 BMI≥50kg/m²。主要结局为任何术中并发症，定义为至少存在 1 种主要术中并发症，包括围手术期输血、术中损伤（肠、膀胱、输尿管损伤；阔韧带血肿）、需要手术干预的宫缩乏力、再次剖腹手术和子宫切除术。使用对数二项式模型在 2 个模型中估计术中并发症的风险比：模型 1 调整了产妇种族和早产（<37 周）；模型 2 调整了模型 1 中的混杂因素以及紧急剖宫产和皮肤切口类型。
共有 51218 名妇女接受了剖宫产术；38%的人 BMI 为 18.5 至 29.9kg/m²，47%的人 BMI 为 30 至 39.9kg/m²，12%的人 BMI 为 40 至 49.9kg/m²，3%的人 BMI≥50kg/m²。术中并发症并不常见（3.4%）：BMI 为 18.5 至 29.9kg/m²的患者为 3.8%，BMI 为 30 至 39.9kg/m²的患者为 3.2%，BMI 为 40 至 49.9kg/m²的患者为 2.6%，BMI≥50kg/m²的患者为 4.3%（P<0.001）。在完全调整的模型 2 中，BMI 为 40 至 49.9kg/m²的妇女与 BMI 为 18.5 至 29.9kg/m²的妇女相比，任何术中并发症的风险较低（调整风险比 [ARR]，0.76；95%置信区间 [CI]，0.64 至 0.89）。BMI 为 30 至 39.9kg/m²的妇女与非肥胖妇女相比，发生任何术中并发症的风险相似（ARR，0.93；95%CI，0.84 至 1.03）。在超级肥胖的妇女中，证据表明急诊剖宫产术存在效应修饰。与非肥胖妇女相比，非急诊剖宫产术的超级肥胖妇女（ARR，1.13；95%CI，0.84 至 1.52）或急诊剖宫产术的超级肥胖妇女（ARR，0.59；95%CI，0.32 至 1.10）的术中并发症风险均未增加。
与剖宫产术后并发症的风险相比，肥胖妇女的术中并发症风险似乎并未增加，即使是在超级肥胖的妇女中也是如此。
