Pathophysiological and Perioperative Features of Morbidly Obese Parturients

Yigal Leykin; Tommaso Pellis

Disclosures

Expert Rev of Obstet Gynecol. 2009;4(3):313-319. 

In This Article

Complications

When considering pregestational obese women, and not maternal weight gain, there is a higher risk of obstetric complications, both maternal and neonatal (Box 1). Obesity has also been identified as a significant risk factor for anesthesia-related maternal mortality.[22] Even in moderately overweight mothers (BMI: 25-30 or 120-150% of ideal bodyweight), the incidence of perinatal infant death was 1.2- to 2.5-fold higher than in normal weight women.[38,39]

Associations between obesity during gestation and hypertensive disorders, diabetes and delivery by cesarean section are well documented.[12] The rate of cesarean deliveries in obese women is 1.2- to 3.0-fold higher when compared with normal-weight patients.[36] Obesity is an intrinsic risk factor for both increased surgical blood loss and postpartum hemorrhage.[40]

In the obese parturient, there is a higher risk of delivery and postpartum complications (Box 1). An increased risk of venous thromboembolic events, mainly due to hemoconcentration, has also been demonstrated.[41] Hence, hospital stay is inevitably longer (on average, 4.43 days) than in lean women, with increased hospitalization costs.[36]

A recent review on the effect of obesity on pregnancy and the impact of bariatric surgery concluded that when surgery is performed sufficiently ahead of planned pregnancy, thereby allowing effective weight reduction, perinatal outcome is comparable to that of the general population.[42]

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