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Obesity as an Independent Risk Factor for Infectious Morbidity in Patients Who Undergo Cesarean Delivery

From the Department of Obstetrics and Gynecology, Texas Tech Health Sciences Center at Amarillo, Amarillo, Texas.

Address reprint requests to: Thomas D. Myles, MD, St. Louis University, 6420 Clayton Road, Suite 559, St. Louis, MO 63117; E-mail: mylesth{at}slucare1.sluh.edu.

OBJECTIVE: Our purpose was to evaluate obesity (body mass index greater than 30.0) as an independent risk factor for infectious morbidity in women having elective or non-elective cesarean deliveries.

METHODS: Charts of 611 patients undergoing cesarean were reviewed. After exclusion of those with pre-existing chorioamnionitis, 574 cases were separated into two groups (elective or nonelective cesarean) and then subdivided based on the presence or not of postdelivery infectious morbidity. Estimated blood loss, operative time, number of vaginal examinations, labor length, use of internal monitors, body mass index (BMI), and obesity (BMI greater than 30.0) were then recorded. Student t test, ², multivariate analysis, and receiver operating characteristics curves were used where appropriate (significance: P < .05).

RESULTS: The mean gestational age at delivery was 38.3 weeks. Three hundred sixty patients had nonelective cesareans, and 214 had elective cesareans. Prophylactic antibiotics were used for 86.6% of the nonelective group and 75.2% of the elective group. In the nonelective group and after multivariate analysis, significant risk factors for postoperative infections were as follows: labor length (18.4 hours versus 10.9, P < .003), number of vaginal examinations (6.1 versus 4.5, P < .001), BMI (36.6 versus 32.3, P < .001), and obesity (81.8% versus 57.3%, P < .001). For the elective group, a higher BMI (38.9 versus 32.2, P < .003), and black race (63.2% versus 11.5%, P < .001) were found to be significant.

CONCLUSION: Our data suggest that obesity is a independent risk factor for postcesarean infectious morbidity and endomyometritis, even if the cesarean is elective and prophylactic antibiotics are given.

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