It’s time to finish our concentrate this Cesarean Awareness Month on the over-utilization of cesareans in women of size and the burdens this higher rate imposes on this group. Look at a new study just out that shows that women of size might benefit from a bigger dosage of antibiotics if they undergo a Cesarean.
This further supports the thought of the need for weight-based dosing of certain types of antibiotics, when folks of size undergo other surgeries as well. Wound an infection is an extremely significant threat of Cesarean sections in women of size, especially “morbidly obese” women. Area of the reason behind this is that adipose tissue tends to be poorly vascularized and oxygenated, rendering it harder for that one area to recover as effectively.
However, another reason behind a higher infection risk may be that “obese” women are being under-dosed with antibiotics when standardized dosing (the same for any weights) can be used instead of weight-based dosing. With this new research, the same standardized antibiotic program was given to all women (regardless of size) undergoing a planned Cesarean delivery. Women were classified by BMI and then tested to see how well the dose was working at differing times during the delivery (incision time, closure time).
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The antibiotic dose was fine for everybody for gram-positive bacteria, however the tale was significantly different for gram-negative bacteria. One-third of the “extremely obese” women (BMI higher than 40 in this study) did not achieve minimal inhibitory concentrations at skin incision, and 44% didn’t achieve minimal inhibitory concentrations at closure.
So by the end of the surgery, almost HALF of the women with a BMI higher than 40 didn’t have enough concentration of antibiotics in their cells to effectively defend against a gram-negative an infection. For years, doctors have blamed all sorts of factors for the higher rate of wound contamination in excess fat women. And to be fair, several factors are relevant.
However, this study shows it’s likely that fat women likewise have higher rates of wound attacks because their doctors are inadvertently undergoing them with antibiotics. We in the excess fat approval community have been informing them this for a long time, but overall doctors have been very slow to listen and heed our responses.
Why has it used the medical community so long to listen? Will this research change the typical of care finally? I’m not holding my breath. The lessons from this study are twofold. First, for when a “morbidly obese” mother truly needs a Cesarean, doctors should explore weight-based dosing with certain types of antibiotics and then study this practice to see if this lessens the risk of infection.
