Experience has shown that pregnant obese women who undergo cesarean delivery have a higher risk of surgical site infection. The reason, according to one hypothesis, could be that the standard dose of prophylactic antibiotics given to all pregnant women is not sufficient for obese pregnant women.
Lindsay Maggio, MD, a fellow in the Division of Maternal-Fetal Medicine at The Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, a Care New England hospital, conducted a randomized controlled trial to test this hypothesis. Last week, that research was selected as the nation's best fellow research paper at the Society for Maternal-Fetal Medicine's annual meeting. Each year, thousands of papers are submitted for consideration in this highly-regarded research venue. Of those, fewer than 50 percent are accepted for presentation. Only the best eight submissions are eligible for the Fellow's Plenary Presentation, and just one wins the coveted award.
"The hypothesis was that the prophylactic antiobiotic dose is not sufficient to reach a high enough concentration in the adipose tissue of obese women. Therefore, it would be ineffective in minimizing infection," explained Dr. Maggio. "We randomized women to receive either the standard two gram cefazolin dose or an increased three gram dose and biopsied adipose tissue twice during the cesarean delivery. We then measured the cefazolin concentrations in the adipose tissue and found that both doses of antibiotics had similar adipose tissue concentrations. In other words, the higher dose of prophylactic antibiotic failed to achieve significantly higher adipose tissue concentrations, which could mean that it will not be any better at preventing infections."
The research, entitled "Optimal dosing of cefazolin in obese women undergoing cesarean delivery: a double-blinded randomized controlled trial," was led by Dr. Maggio, along with her Women & Infants/Brown University colleagues Dwight Rouse, MD, MSPH, and Brenna (Anderson) Hughes, MD, MSc, as well as colleagues at Hartford Hospital's Center for Anti-Infective Research and Development in Hartford, CT.
The Society of Maternal-Fetal Medicine was established in 1977 to give maternal-fetal medicine physicians and scientists a place to share knowledge, research and clinical best practices in order to improve care for moms and babies. Maternal-fetal physicians are obstetricians with additional training in the area of high-risk, complicated pregnancies.
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the 11th largest stand-alone obstetrical service in the country with approximately 8,400 deliveries per year. A U.S.News & World Report 2014-15 Best Children's Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country's largest, single-family room neonatal intensive care unit.
Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the Pelvic Floor Disorders Network.