Title: Perioperative Management of Obese Parturients
Volume: 6
Issue: 4
Author(s): Rajesh Dumpala, Sudarshan Gururajarao and Sarvana Kumar
Affiliation:
Keywords:
Obstetric anaesthesia, obesity, pregnancy, labour analgesia, complications, perioperative management, Obese Parturients, cardiovascular diseases, diabetes mellitus type 2, apnoea, cancer, osteoarthritis, anaesthetic mortality, Obste-tricians, Anaesthetists, antenatal disease, preeclampsia, gestational diabetes, perinatal care, regional anaesthesia, physiotherapy, T2DM, Body Mass Index, Supine hypotension syndrome, intra-gastric pressures, Aortocaval compression, Pro-thrombotic state, thromboembolic disease, pyrexia of unknown origin, haemolysis, elevated lever enzymes, low platelets, Continuous Positive Airway Pressure, venous thromboembolism, meconium aspiration, shoulder dystocia, postpartum haemorrhage, congenital anomalies, spina bifida, omphalocele, cardiac anomalies, suboptimal ultrasound visualization, intracranial anomalies, lactogenesis, prolactin, Analgesia, epidural analgesia, Cochrane systematic review, surgical anaesthesia, Combined spinal epidurals, transcutaneous electrical nerve, Opioids, Remifentanil, hypoxemia, atelectasis, throm-boembolism, pulmonary oedema, cardiomyopathy, endo-metritis, low molecular weight heparins
Abstract: Obesity is a public health problem that continues to rise despite preventive strategies. There is an association between excessive body weight and various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnoea, certain types of cancer, and osteoarthritis. Obesity adds to anaesthetic mortality and morbidity as well.
The incidence of obesity in pregnant population is also on the rise. These patients pose considerable challenges to Obstetricians and Anaesthetists not only with increased co-morbidities but they also need higher level of technical skills. Obese parturients are at increased risk of superimposed antenatal disease such as preeclampsia and gestational diabetes. They have a tendency to labour abnormally, contributing to increased instrumental delivery and caesarean sections. Thus, obesity is associated with increased perioperative morbidity and mortality.
These patients should have multidisciplinary assessment involving midwives, obstetricians and anaesthetists to plan their perinatal care. Midwives must prepare for this epidemic and must endeavour to help women who want to lose weight and dispel the myth that this cannot be achieved safely during pregnancy. In spite of technical difficulties, regional anaesthesia may reduce anaesthesia-related morbidity and mortality. Effective pain relief, chest physiotherapy and early mobilisation should be included in postoperative care.
