Thomas D. Myles

Obesity as an Independent Risk Factor for Infectious Morbidity in Patients Who Undergo Cesarean Delivery

OBJECTIVE Our purpose was to evaluate obesity (body mass index greater than 30.0) as an independent risk factor for infectious morbidity in women having elective or non‐elective cesarean deliveries. METHODS Charts of 611 patients undergoing cesarean were reviewed. After exclusion of those with pre‐existing chorioamnionitis, 574 cases were separated into two groups (elective or nonelective cesarean) and then subdivided based on the presence or not of postdelivery infectious morbidity. Estimated blood loss, operative time, number of vaginal examinations, labor length, use of internal monitors, body mass index (BMI), and obesity (BMI greater than 30.0) were then recorded. Student t test, χ2, multivariate analysis, and receiver operating characteristics curves were used where appropriate (significance: P < .05). RESULTS The mean gestational age at delivery was 38.3 weeks. Three hundred sixty patients had nonelective cesareans, and 214 had elective cesareans. Prophylactic antibiotics were used for 86.6% of the nonelective group and 75.2% of the elective group. In the nonelective group and after multivariate analysis, significant risk factors for postoperative infections were as follows: labor length (18.4 hours versus 10.9, P < .003), number of vaginal examinations (6.1 versus 4.5, P < .001), BMI (36.6 versus 32.3, P < .001), and obesity (81.8% versus 57.3%, P < .001). For the elective group, a higher BMI (38.9 versus 32.2, P < .003), and black race (63.2% versus 11.5%, P < .001) were found to be significant. CONCLUSION Our data suggest that obesity is a independent risk factor for postcesarean infectious morbidity and endomyometritis, even if the cesarean is elective and prophylactic antibiotics are given.

Medical Licensure Examination scores: Relationship to Obstetrics and Gynecology Examination scores

OBJECTIVE We studied the correlations between both Step 1 and Step 2 of the United States Medical Licensure Examination (USMLE) and the National Board of Medical Examiners Obstetrics and Gynecology Examination (NBME‐OB/GYN). METHODS From July 1994 until June 2001, all third‐year medical students at Texas Tech University Health Center at Amarillo were studied. The scores from the first attempts for the three examinations were obtained. We investigated for correlations between the examination scores and the score extremes. RESULTS A total of 258 students were evaluated. The mean USMLE Step 1 score was 203.7; mean score for Step 2 was 205.0. The NBME‐OB/GYN final examination was 86.0. We found linear correlations between the NBME‐OB/GYN and the USMLE Step 1 (r = .463, P < .001) and USMLE Step 2 (r = .595, P < .001), as well as between the USMLE Steps 1 and 2 (r = .666 P < .001). Students failing the USMLE Step 1 were more likely to fail their USMLE Step 2 (relative risk [RR] 9.3 [95% confidence interval (CI) 2.1, 41.0]) and/or the NBME‐OB/GYN (RR 3.3 [95% CI 1.03, 10.8]). Students scoring in the lowest 25th percentile of the NBME‐OB/GYN were more likely to fail the USMLE Step 2. CONCLUSION Both USMLE Steps 1 and 2 correlated with the NBME‐OB/GYN scores, as well as with each other. Students failing either the USMLE Step 1 or NBME‐OB/ GYN were more likely to fail the USMLE Step 2. The use of this information could predict students at risk for low scores on future examinations.