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Article Title

Severe Obesity on Labor and Delivery: Variation in Hospital Resources Among California Hospitals

Publication Date

4-30-2015

Keywords

hospital resources, severe obesity

Abstract

Background/Aims: More than half of pregnant women are overweight and 8% of reproductive aged women are extremely obese. Rates of maternal obesity and obstetrical complications associated with obesity are increasing. How hospitals are responding to this trend in terms of both clinical practices and resources is unknown. The objective of this study is to describe how labor and delivery (L&D) units in California are equipped to care for women with extreme obesity.

Methods: A cross-sectional study based on a survey instrument designed and validated to collect information on childbirth practices and resources from nurse managers on L&D units in all California hospitals. Based on responses to specific survey items, hospitals were stratified by type (Community, Teaching, and Integrated Delivery System [IDS] hospitals) and obesity resources (low level [LL] — at least one key piece of equipment not available in hospital; intermediate level [IL] — all equipment available in hospital but not kept on L&D; and high level [HL] — all equipment available in hospital and kept on L&D). Survey questions identified hospitals that transfer out women and ascertained the availability of the following resources to accommodate women with severe obesity: operating table, special gurney, surgical instruments and retractor equipment.

Results: Nearly all hospitals responded to the survey (239/248 [96%]). There were 187 community hospitals, 27 teaching hospitals and 25 IDS hospitals. Of these, there were 77 HL (32.2%), 143 IL (51.5%) and 39 LL (16.3%) hospitals. Of the 25 IDS hospitals, there were 15 HL (60%), 8 IL (32%) and 2 LL (8%). Only one IDS hospital reported that they had ever transferred a patient out for extreme obesity and this was a LL hospital.

Discussion: Hospitals vary by resources available to manage obese patients. IDS hospitals are better equipped to care for obese patients with nearly twice as many HL IDS hospitals than the total hospital sample. The extent to which this is associated with patient outcomes remains to be determined and is the focus of ongoing research. Primary outcomes should include cesarean delivery rates and composite maternal morbidity among obese patients who delivered at hospitals with LL, IL and HL obesity resources

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