Cesarean delivery in the obese parturient: anesthetic considerations

A Comparative Study of Maternal and Neonatal Outcomes in Obese and Non-obese Iraqi Pregnant Women Undergoing Cesarean Section

BACKGROUND

Obesity has become a global health concern, and it is on the rise in developed nations among both the general and the obstetric populations. To know if a person has obesity or normal body weight, the body mass index (BMI) is now widely used and regarded as a trustworthy indicator.

AIM

This study was designed to compare maternal and neonatal outcomes between obese and non-obese pregnant women who underwent cesarean section (C/S) in Basra city in the south of Iraq.

METHOD

This comparative observational cross-sectional study was done in Basra Teaching Hospital, Basra, Iraq, from May 10, 2024, to November 10, 2024, on 206 pregnant women aged between 15 and 50 years old who underwent C/S delivery. The participants were subdivided into three groups according to their BMI: group one: normal weight (n = 64) with a BMI of 18.5-24.9 kg/m², group two: overweight (n = 79) with a BMI of 25-29.9 kg/m², and group three: obese (n = 63) with a BMI of ≥30 kg/m². A study of their preoperative data, including age, blood pressure, BMI, educational level, occupation, gestational hypertension, gestational diabetes mellitus (GDM), previous abortion, previous stillbirth, parity, number of previous C/S, and gestational age, and correlations with their postoperative findings; postpartum hemorrhage (PPH), the time of initial mobility from bed after surgery, the time of starting breastfeeding, the time of starting intestinal sounds, macrosomia, and admission of neonates to the intensive care unit (NICU) was recorded, analyzed, and compared for all three groups. The statistical significance level is considered the p-value < 0.05.

RESULTS

The results demonstrated a clear correlation between maternal and neonatal complications following C/Ss and increased BMI. High BMI was substantially related to maternal factors that differed considerably across the groups, including education level (p-value = 0.001), parity (p-value ≤ 0.001), and the number of previous C/S (p-value = 0.011). Prenatal problems such as GDM (p-value = 0.042) and gestational hypertension (p-value = 0.016) also showed a significant difference, with the obese group experiencing greater rates than the overweight and normal groups. The results showed that there was a significant difference related to maternal postoperative outcomes like the initial time of returning intestinal sounds (p-value = 0.026), the initial time of starting mobility (p-value ≤ 0.001), and the initial time of starting breastfeeding (p-value ≤ 0.001), as well as neonatal postoperative outcomes like macrosomia (p-value = 0.030) and neonatal admission to the NICU (p-value = 0.001); they were also higher in the obese group. Also, the obese group has a longer duration of surgery (p-value ≤ 0.001) and hospital stay (p-value ≤ 0.001) than the other groups. The results showed a non-significant difference regarding PPH among the study groups.

CONCLUSION

The study concluded that obesity has adverse effects on pregnancy outcomes for mothers and their infants. A low educational level is associated with high BMI, leading to high risks of postoperative complications. Gestational diabetes and gestational hypertension are more frequent in obese women. Obese women should be considered high-risk and recommended to maintain weight to reduce any complications after surgery.

Obesity at term: What to consider? How to deliver?

Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.

Postoperative Respiratory Compromise following Cesarean Birth: The Impact of Obesity and Systemic Opioids

Objective  The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean. Methods  Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated. Results  Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021-1.108], p  = 0.003), and MME (odds ratio = 1.005 [95% CI: 1.002-1.008], p  = 0.003), adjusting for magnesium sulfate use. The interaction between obesity and opioid dose demonstrated an odds ratio of 1.000 (95% CI: 0.999-1.000, p  = 0.030). Conclusion  The proportion of women experiencing respiratory events following cesarean birth increases with the degree of obesity and opioid dose. Key Points Respiratory events increase with obesity.Respiratory events increase with systemic opioid use.Odds ratio of respiratory events is 1.063/unit BMI increase.

Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m-2

An increasing number of women with a body mass index (BMI) ≥ 60 kg m⁻², referred to as super-super obesity, are requiring anesthetic care for labor and delivery. Management of these patients presents obstetric, anesthetic, and logistical challenges. We report our experience in the management of cesarean delivery in a parturient with a BMI of 112 kg m⁻². Use of epidural anesthesia and performance of a supraumbilical transverse surgical incision with caudal placement of the panniculus resulted in optimal hemodynamic and ventilatory parameters. Effective multidisciplinary planning and communication is key. We present this case to highlight decision-making strategies and elucidate our approach in the management of this complex obstetric case.

Maternal and fetal outcomes following unplanned conversion to general anesthetic at elective cesarean section

OBJECTIVE

To investigate risk factors predicting unplanned conversion to general anesthesia during elective cesarean section, and to examine maternal and fetal outcomes associated with unplanned conversion compared with other modes of anesthesia.

STUDY DESIGN

A retrospective cohort at a UK center (2008 to 2013). Women (4337) underwent elective cesarean section. Delivery outcomes were compared according to anesthesia type using logistic regression.

RESULT

Women (1.6%) underwent unplanned conversion to general anesthetic. Unplanned conversion was associated with higher parity (odds ratio (OR) 3.82, confidence interval (CI; (1.58 to 9.62)) and maternal age ⩾40 (OR 4.40, CI (1.08 to 29.88)). Compared with spinal anesthetic, unplanned conversion was associated with increased likelihood of maternal hemorrhage ⩾1.5 l (OR 5.74, CI (1.90 to 14.01)) and delayed neonatal respiration (OR 4.76, CI (1.76 to 11.05)). Adverse outcomes were not significantly more likely compared with planned general anesthetic.

CONCLUSION

Higher parity and maternal age are risk factors for unplanned conversion to general anesthetic. There is no increase in the likelihood of adverse outcomes with unplanned versus planned general anesthetic.