754: Post-cesarean maternal complications in patients with extreme obesity

754 Post-cesarean maternal complications in patients with extreme obesity David Stamilio, Molly Stout, George Macones, Christina Scifres Washington University School of Medicine, Obstetrics and Gynecology, St. Louis, MO, University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA OBJECTIVE: Obesity is epidemic, representing a substantial disease burden. Although obesity is known to increase pregnancy complications, maternal post-operative risks among obese patients that require cesarean delivery are not well characterized. STUDY DESIGN: We performed a secondary analysis of a randomized controlled trial to estimate the effect of obesity on post-cesarean complications. The parent study was designed to estimate the effect of supplemental oxygen on post-cesarean infectious morbidity. Since study intervention had no effect, study groups were combined as a cohort. Exposure is obesity, stratified as normal/overweight (BMI 30 kg/m2), obese (BMI 30-45 kg/m2) or extremely obese (BMI 45 kg/m2). The primary outcome is a composite of wound infection and endometritis. Secondary outcomes include the composite components and wound opening, hematoma or seroma, and emergency department visit. We performed unadjusted and multinomial logistic regression analyses. Adjusted relative risk ratios (RRR) and 95% confidence intervals (CI) are reported. RESULTS: 585 women were included in the analysis. Infectious morbidity occurred in 10.4% of all patients. Rates of normal/overweight and obesity class I, II, and III were 25.1%, 30.1%, 14.9% and 29.9% respectively. Eighty-five patients (14.5%) had a BMI 45 kg/m2. 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 undergo cesarean after labor and require a vertical skin incision or classical uterine incision. After controlling for relevant confounders, extremely obese patients had a 2-4 fold increase in postoperative complications. CONCLUSION: Maternal obesity is associated with a significant increase in post-cesarean wound complications. Risk is concentrated among class III obesity patients with BMI 45 kg/m2. These data can be used to counsel obese patients on operative risks and to target methods to reduce the risk of cesarean in extremely obese patients. 755 Impact of maternal obesity on perinatal infectious morbidity Michael Fassett, Deborah Wing, Darios Getahun Kaiser Permanente West Los Angeles Medical Center, Obstetrics and Gynecology, Los Angeles, CA, University of California Irvine, Obstetrics and Gynecology, Irvine, CA, Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA OBJECTIVE: Maternal obesity is an increasing public health problem. Studies have suggested that obesity increases placental inflammation. The aim of this study was to examine whether obesity is associated with increased risk of perinatal infectious morbidity. STUDY DESIGN: We conducted a retrospective cohort study using the 2006-2010 Kaiser Permanente Southern California medical record (n 154,275). ICD-9-CM codes from the maternally-linked hospitalizations and birth certificate data were used to examine the associations. Prepregnancy Body Mass Index (BMI, kg/m2) was defined as normal-weight (18.5-24.9), overweight (25-29.9), and obese ( 30).Odds ratio (OR) and 95% confidence interval (CI) were used to estimate the magnitude of associations after adjusting for potential confounders. RESULTS: Of the women in the study, 29 percent were overweight and 27 percent were obese. When compared to women of normal weight, overweight and obese women had a 1.31 -fold (95% CI 1.14, 1.51) and 2.11-fold (95% CI 1.86, 2.40) increased risk of surgical site infection and a 1.11-fold (95% CI 1.06, 1.16) and 1.28-fold (95% CI 1.22, 1.34) increased risk of urinary tract infection, respectively. Obesity was associated with increased risk of endometritis (OR 1.18, 95% CI 1.00, 1.41), GBS infection (OR 1.21, 95% CI 1.15, 1.27) and acute cystitis (OR 1.17, 95% CI 1.02, 1.33). CONCLUSION: The findings suggest that obese women are at increased risk for perinatal infectious morbidity and may benefit from interventions targeted at reducing infectious morbidity.