The group randomised to vaginal delivery would contain a proportion of
successful vaginal deliveries which would then fare much better.
--
________________________________
Daniel Braun
Sent: Saturday, 26 May 2007 1:21 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Delivery suggestions
If you read a little higher than their conclusions, you will see the
following:
"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),"
All of these are factors shown to increase perioperative morbidity.
If someone were ever to randomize these patients to 2 groups; elctive
C/S vs attempted vaginal delivery; and then compare outcomes, My opinion
is that the second group, i.e. attempted vaginal delivery would fare
much worse.
Dan
On 5/24/07, Raymond Stephen <stephen.raymond@dhhs.tas.gov.au> wrote:
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
<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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--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is
BLIND"
Einstein 1941
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