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Re: Delivery suggestionsFrom: Henry Gregor (henrygregor@yahoo.com)Sat May 26 20:31:13 2007
Good points Dan...again, as mentioned earlier, Dwight Cruikshank studied CS in obese patients (he first did it in Iowa, where they grow a lot of corn. On first request for patient charts for study review, he has said, he was so inundated he had to define morbid obesity up to a higher level to keep things manageable). Main conclusion was that the major contributor to CS morebidity was not patient BMI, but the tendency of physicians to go to lengths to avoid one, out of concern for possible complications from weight....and thus, one gets into the issues noted by Dan. I believe Dr. Cruikshank did similar analyses with similar results in other settings after that first study. H "R. Daniel Braun" <rd.braun@gmail.com> wrote: 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 deliveryu 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] 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: CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
-- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine
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