OBJECTIVE: To examine the relationship between body mass index (BMI, kg/m) and incision-to-delivery interval and total operative time at cesarean delivery. METHODS: Women with singleton gestations undergoing uncomplicated primary and repeat cesarean deliveries were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Women were classified by BMI category at time of delivery (normal 18.5-24.9, overweight 25.0-29.9, obese 30.0-39.9, and morbidly obese 40 or greater). Incision-to-delivery interval and total operative times during cesarean delivery were compared among the three groups. Primary outcome was prolonged incision-to-delivery interval as defined by 90th percentile or greater of the study population or 18 minutes or longer. RESULTS: Of the 21,372 women included in the analysis, 9,928 were obese (46.5%) and 2,988 (14.0%) were morbidly obese. Longer operative times were found among women with overweight (median [interquartile range] incision-to-delivery: 9.0 [6.0] and total operative time: 45.0 [21.0] minutes), obese (10.0 [7.0]; 48.0 [22.0] minutes), and morbidly obese BMIs (12.0 [8.0]; 55.0 [26.0] minutes) compared with women with normal BMI at delivery (9.0 [5.0]; 43.0 [20.0] minutes) (P<.001). Morbidly obese women had a more frequent incision-to-delivery interval that was 18 minutes or longer (n=602 [20%] compared with 127 [6%] in normal BMI). After adjustments including number of prior cesarean deliveries, incision-to-delivery interval 18 minutes or longer was significantly related to obese (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.31-2.03) and morbidly obese (OR 2.81, 95% CI 2.24-3.56) BMI at delivery. CONCLUSION: Increasing BMI is related to increased incision-to-delivery interval and total operative time at cesarean delivery with morbidly obese BMI exposing women to the highest risk of prolonged incision-to-delivery interval.
BACKGROUND: Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients. METHODS: One hundred sixty morbidly obese (≥40 kg/m(2)) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded. RESULTS: Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively. CONCLUSION: Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone.