Obesity is a growing epidemic on the rise in the United States, currently affecting around 1/3 of the population. The National Vital Statistics Report for 2016 using birth certificate data from 2014 demonstrated 50.4% of women who gave birth were overweight or obese . Obesity increases antenatal complications and peripartum morbidity. Among pregnant women who undergo cesarean delivery, maternal obesity increases both intra- and post-operative complications including increased operative times, higher amount of blood loss, prolonged length of stay as well as increased post-operative wound complications , posing additional challenges for obstetric providers. Due to these increased risks, maternal class III obesity is often a reason for transfer to a tertiary center.
The purpose of this consensus statement is to provide perioperative guidelines that need to be considered when performing a cesarean section in an obese gravida. Three specific issues addressed include: 1) surgical skin incision placement for cesarean delivery, 2) prophylactic negative pressure therapy after cesarean delivery and 3) use of self-retaining retractors.