Background
As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period.
Study Design
The present study is a secondary analysis of women who underwent cesarean delivery and had BMI > 40 kg/m2 in the Maternal Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2).
Results
Rates of postpartum infectious morbidity increased with BMI category (11.7% body mass index 50-59.9 kg/m2; 13.7% BMI 60-69.9 kg/m2, 21.9%; and BMI >70+ kg/m2; p=0.001). Readmission for wound complications also increased with BMI (3.1% for BMI 50-59.9 kg/m2; 6.2% for BMI 60-69.9 kg/m2; and 9.4% for BMI >70+kg/m2; p=0.001). After adjusting for confounders, increased BMI 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared to women with BMI 40-49.9 kg/m2 (aOR 6.38; 95% CI 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR 2.33 (95%CI 1.35-4.02) BMI 50-59.9kg/m2, aOR 4.91 (95% CI 2.07-11.7) BMI 60-69.9kg/m2, aOR 36.2 (7.45-176) for BMI >70kg/m2).
Conclusion
Women with BMI 50-70+kg/m2 are at an increased risk of postpartum wound infections and complications compared to women with BMI 40-49.9kg/m2. These data provide increased guidance for counseling women with an extremely elevated body mass index and highlight the importance of postpartum wound prevention bundles.
hypertensive disorders of pregnancy in our lower socio-economic population. Our primary aim was documentation of BP in 75% of telehealth visits within 10 weeks for WC patients with estimated gestational age (EGA) > 28 weeks or earlier if diagnosis of hypertension, history of hypertensive disorder of pregnancy, obesity, or renal disease. Our secondary aim was to prevent worsening of disparities for patients with Medicaid insurance and those who speak English as a second language. STUDY DESIGN: A needs assessment was completed during the first week of instituting telehealth visits. The process map was created, and a driver diagram identified primary and secondary drivers and nine change concepts (Fig 1). All nine interventions were applied over ten weeks by a multidisciplinary team of APRNs, RNs, midwives, and MDs. This study involved weekly chart review of WC telehealth visits. RESULTS: Documentation of BP in telehealth visits of included patients was 5% in the first week. As interventions were implemented, documentation increased to over 50% by week 5, and up to 89% by week 10, at which time our providers completed an average of 10 telehealth visits for included patients per day (Fig 2). The average number of telehealth visits with home BP documented over weeks 10-17 was 70.3%. Additional analysis revealed no significant difference in percentage of visits with documented BP of patients who identified English as a primary versus other primary language. Noted barriers to documentation were analyzed. CONCLUSION: This project demonstrates that, when utilized by a multidisciplinary team, quality improvement science can lead to effective and rapid adjustments in healthcare delivery without compromise to at risk populations. This process can be replicated as we consider adaption in a second COVID-19 wave.
A 20 year-old female at 27-week gestation was admitted for threatened preterm delivery. Following an initially unremarkable hospital course for 12 days, the patient developed fever, chills, generalized malaise, abdominal pain, and diffuse myalgias on day 13 of hospitalization. Raoultella species was isolated from blood cultures on day 16 of hospitalization. The patient’s condition improved within 24 hours of symptom onset, prior to antibiotic initiation, and a premature, viable male infant at 29 weeks and 6 days of gestation was delivered via caesarean section four days later due to breech presentation in the setting of preterm labor. Here, we present the first case of a Raoultella species infection in a gravid female reported in the literature.
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