Cesarean delivery complications in women with morbid obesity

Objective: To compare cesarean complication rates between women with body mass index (BMI) 40-49.9kg/m(2) and BMI50kg/m(2) and associations with surgical techniques.Methods: This retrospective cohort study from 2009 to 2014 included women who underwent cesarean with delivery BMI50 and an equal number with BMI 40-49.9. Wound infections and/or separations were compared. We also examined wound complication rates between skin closure techniques and self-retaining retractor use.Results: Among 498 patients (249 with BMI50 and 249 with BMI 40-49.9) there were no differences in estimated blood loss >1000mL, blood transfusion, deep vein thrombosis or endometritis. Among those with outpatient follow-up (144 with BMI50 and 162 with BMI 40-49.9), those with BMI50 had a significantly higher rate of wound separations (p=0.01) but not infections. There were no differences in wound complication rates between skin closure techniques or self-retaining retractor use, though the study was not powered for these comparisons.Conclusion: Wound complications, particularly separations, increase with BMI50 compared to a lesser degree of morbid obesity. Skin closure techniques and self-retaining retractor use were not associated with cesarean wound complications in patients with morbid obesity.