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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Operative Obstetrics

Poster Session 4

(1010) Perioperative resource utilization, practice patterns and outcomes for high BMI patients undergoing cesarean delivery.

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Foundation Awardee
Objective:
Despite evidence of increased perioperative risk for high BMI patients undergoing cesarean delivery, resource utilization rates are poorly characterized and tailored evidence-based guidelines are lacking. This study aimed to describe perioperative resource utilization rates, practice patterns and outcomes in patients with high BMI and without to identify clinical gaps.

Study Design:
We analyzed electronic health record data in a standardized common data model from a single, high volume academic institution between 2015 to 2023. We included patients with BMI 15-80 and stratified by delivery BMI < 30, BMI 30-39.9 and BMI ≥40. Resource and practice pattern variables included obstetric anesthesia consultation, anesthesia type, 3 g cefazolin prophylactic antibiotic use, pharmacologic venous thromboembolism (VTE) prophylaxis, midline vertical skin incision, and Alexis and pannus retractor use. Maternal outcomes included incision to delivery interval, quantitative blood loss, hemorrhage (PPH), uterotonic medication use, transfusion, VTE, surgical site infection (SSI) and postpartum readmission. Neonatal outcomes included 5-minute APGAR < 7 and birthweight in grams. 

Results:
Among 8,560 patients delivered by cesarean, 4,507 (52.6%) had BMI < 30, 3,362 (39.3%) had BMI 30-39.9 and 691 (8.1%) had BMI ≥40. Potentially risk-reducing resource utilization rates for patients with BMI ≥40 were low; 400 (58%) patients underwent obstetric anesthesia consultation, 260 (38%) received 3 g cefazolin, 53 (7.7%) utilized a pannus retractor, 135 (20%) utilized an Alexis retractor and 218 (32%) received pharmacologic VTE prophylaxis. Incision to delivery interval, conversion to general anesthesia, midline skin incision, PPH, SSI, VTE and postpartum readmission were observed at higher rates in the BMI ≥40 cohort, as was 5-minute APGAR < 7.  

Conclusion:
Despite higher morbidity for high BMI patients undergoing cesarean, there is wide variability in practice and underutilization of potentially risk-reducing resources. Future research across institutions should investigate barriers and solutions.