Panniculus retractor use during scheduled cesarean section: potential neonatal impact

Use of a disposable panniculus retractor (DPR) during cesarean section (CS) improves surgical site visualization in obese women. However, whether this redistribution of weight onto the uterus and abdominal vasculature just prior to delivery impacts neonatal outcomes is unclear. To assess the potential downstream effect of DPR, we investigated neonatal outcomes after scheduled CS for deliveries using DPR. A retrospective cohort study of term pregnant patients with body mass index (BMI) ≥ 40.00 kg/m2 who underwent a scheduled CS at a tertiary care center from June, 2018 to May, 2019. CS using a DPR were compared to those without. Exclusion criteria included multiple gestation, fetal anomalies and general anesthesia. Universal umbilical artery (UA) cord gas collection is performed at our institution. The primary outcome was UA pH. Secondary outcomes were UA pH< 7.1, APGAR scores at 1 min and 5 min, neonatal intensive care (NICU) admission, and other UA gas parameters. Descriptive statistics and univariate analysis were performed. Multivariable logistic regression was used to adjust for potential confounders. 91 patients met inclusion criteria, including 23 (25.3%) with intraoperative DPR use and 68 (74.7%) without. Patients in the DPR group had a higher BMI (49.4 kg/m2 ±7.8 vs 45.9 kg/m2±6.1 [p=0.03]), and higher rates of drug use (47.8% vs 16.2% [p< 0.01]). UA pH was similar between groups (7.21±0.09 vs 7.24±0.06 [p=0.13]) as was UA pH < 7.1 (4.3% vs 1.5% [p=0.56]). UA lactate was significantly higher in the DPR group (4.0mmol/l±1.9 vs 3.2mmol/l±1.2 [p=0.02]). However, the risk of UA lactate > 4 mmol/l and NICU admission were similar between groups (aRR 2.52 [0.81, 3.53] and aRR 1.92 [0.31, 8.59], respectively). Intraoperative use of DPR did not significantly impact rates of neonatal acidemia at time of delivery. However, as elevated UA lactate represents early hypoxemia, more research is needed to assess the impact of increased lactate and whether this indicates an emerging trend.