Re: Delivery suggestions
From: Dr Eberhard Lisse (el@lisse.NA)
Fri May 25 00:12:47 2007
Steve,
she is a primigravida with twins. We don't even know the presentation.
I would prefer an elective C/S to an emergency C/S.
el
on 5/25/07 4:59 AM Raymond Stephen said the following:
> Am J Obstet Gynecol. 1994 Feb;170(2):560-5.
> Massive maternal obesity and perioperative caesarean morbidity. Perlow
> JH, Morgan MA.
> Department of Obstetrics and Gynecology, Long Beach Memorial Medical
> Center Women's Hospital, California.
>
> OBJECTIVE: Our purpose was to determine the impact of massive maternal
> obesity (weight > 300 pounds) on perioperative morbidity among patients
> undergoing caesarean section.
> STUDY DESIGN: A case-control study was conducted on 43 massively obese
> pregnant women, identified by perinatal database search, who were
> delivered by caesarean section between Jan. 1, 1987, and Dec. 31, 1991,
> at Long Beach Memorial Women's Hospital. Forty-three randomly selected
> patients who underwent caesarean delivery served as the control group.
> Medical records were abstracted for perioperative variables and compared
> between groups. Student t test, chi 2, and Fisher's exact statistical
> analysis were used where appropriate.
> RESULTS: No significant differences were observed between groups for
> maternal age, parity, use of prophylactic antibiotics, length of
> recovery room stay, or wound dehiscence. The massively obese group was
> observed to be at significantly increased risk for emergency caesarean
> section (32.6% vs 9.3%, p = 0.02), prolonged delivery interval (25.6% vs
> 4.6%, p = 0.01), and total operative time (48.8% vs 9.3%, p < 0.0001),
> blood loss > 1000 ml (34.9% vs 9.3%, p = 0.009), multiple epidural
> placement failures (14.0% vs 0%, p = 0.02), postoperative endometritis
> (32.6% vs 4.9%, p = 0.002), and prolonged hospitalization (34.9% vs
> 2.3%, p = 0.0003).
> CONCLUSION: Massively obese pregnant women undergoing caesarean section
> are at significantly increased risk for perioperative morbidity.
>
> PMID: 8116713 [PubMed - indexed for MEDLINE]
>
> Do you still want to do a Caesar?
>
> Steve
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
> Ramirez
> Sent: Friday, 25 May 2007 9:44 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Delivery suggestions
>
> Pray for an easy vaginal - an emergency C/S in this lady?! - if any
> doubt - "easy" C/S - elective .. good luck - I like transverse
>
> Ef
>
>> Wed, 23 May 2007, Lynn Montgomery wrote:
>>
>> I have a good one for y'all to ponder. 23 y.o. primigravida, currently
>> at 34 weeks gestational age with twins. Currently weighs 399. EFW at
>> 31 weeks on both twins was 5 pounds. Cephalic/cephalic presentation.
>> During a visit to L&D for false labor, monitoring was essentially
>> impossible.
>>
>> Route of delivery?
>>
>> Lynn
>>
>> --
>
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--
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