RESUMO
Higher doses of cefazolin are required in obese patients for preoperative antibiotic prophylaxis, owing to its low lipophilicity. An ultra high performance liquid chromatography-tandem mass spectrometry method was developed to quantify cefazolin in serum and adipose tissue from 6 obese patients undergoing cesarean delivery, and using stable-isotope labeled cefazolin as an internal standard. The method has a 2µg/g lower limit of quantitation. The concentration in adipose tissue was 3.4±1.6µg/mL, which is less than half of the reported minimum inhibitory concentration of 8µg/mL for cefazolin. Serum cefazolin concentrations were more than 30-fold higher than in adipose tissue.
Assuntos
Tecido Adiposo/metabolismo , Antibacterianos/metabolismo , Cefazolina/metabolismo , Cesárea , Cromatografia Líquida de Alta Pressão/métodos , Obesidade/metabolismo , Espectrometria de Massas em Tandem/métodos , Tecido Adiposo/química , Adulto , Antibacterianos/sangue , Cefazolina/sangue , Feminino , Humanos , Obesidade/sangue , Projetos Piloto , GravidezRESUMO
OBJECTIVE: Obstetrical risk is increased with maternal obesity. This prospective study was designed to simultaneously evaluate the outcomes in obese parturients and their newborns. METHODS: Patients with a body mass index (BMI) > or =35 were prospectively identified and compared to an equal number of normal weight parturients. Maternal and neonatal outcome measures were compared for the peripartum and neonatal period. RESULTS: We identified 580 obese parturients over a 6 month period and compared them to an equal number of normal weight parturients. The incidence of obesity in this population was 23%. Obesity was associated with increased rates of hypertension, diabetes, and cesarean section. Obese patients were more likely to develop postpartum complications. Neonatal outcomes were compared for infants > or =37 weeks gestation excluding multiple births (496 neonates in the obese group and 520 in the control group). The neonates of obese parturients were more likely to be macrosomic, have 1-minute Apgar scores of < or =7.0 and require admission to a special care unit. Sub-group analysis showed that negative outcomes for parturients and their neonates correlated with increasing BMI. Neonates born to obese diabetic parturients had the highest risk of poor outcomes. CONCLUSIONS: Maternal obesity confers increased risks for both the parturient and their newborn.