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Clinical Trial
. 2023 Dec;55(1):1037-1046.
doi: 10.1080/07853890.2023.2187877.

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section

Patchareya Nivatpumin  1 , Tripop Lertbunnaphong  2 , Siritorn Maneewan  1 , Nutha Vittayaprechapon  1
Affiliations
Clinical Trial

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section

Patchareya Nivatpumin et al. Ann Med. 2023 Dec.

Abstract

Objective: To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section.

Methods: A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations.

Results: The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40-49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups' incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable.

Conclusions: Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section.

www.clinicaltrials.gov ID: NCT04657692.

Keywords: Anesthesia; cesarean delivery; complications; morbid obesity; perioperative outcomes; super obesity.

Plain language summary

Super obesity parturients are at a significantly higher risk of intraoperative bleeding, maternal hypotension, and higher vasopressor requirement compared to parturients with morbid obesity undergoing cesarean delivery.We additionally found a weak positive correlation between patient body weight and intraoperative blood loss in a patient with morbid obesity regardless of anesthetic technique.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow chart of study population. BMI: body mass index; GA: general anesthesia; RA: regional anesthesia; SB: spinal block; EB: epidural block; CSE: combined spinal epidural block.
Figure 2.
Figure 2.
Correlation of maternal body weight and estimated blood loss (n = 494). Spearman correlation coefficient 0.146 (p < 0.001).
Figure 3.
Figure 3.
Comparing of intraoperative blood loss between morbid obesity and super-morbid obesity (n = 494). Graph represented in mean ± 1SD; p-value = 0.039.
See this image and copyright information in PMC

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