Intrapartum Care of the Morbidly Obese Gravida: Ten Guidelines for the Obstetrician

Authors

  • Kecia Gaither

DOI:

https://doi.org/10.14205/2309-4400.2015.03.02.1

Keywords:

Morbid obesity, intrapartum care, morbidity, operative incision, BMI.

Abstract

Obesity has evolved as a major public health issue worldwide, its effects having a significant impact on obstetrical care. Morbidly obese parturients are at a significantly increased risk of complications during the intrapartum period and thus require more intervention. Guidelines are needed to address the intrapartum management of the morbidly obese gravida to reduce the risk of morbidity and mortality.

References

Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world – A growing challenge. N Engl J Med 2007; 356: 213-5. http://dx.doi.org/10.1056/NEJMp068177

Canoy D, Buchan I. Challenges in Obesity Epidemiology. Obes Rev 2007; 8(suppl.1): 1-11. http://dx.doi.org/10.1111/j.1467-789X.2007.00310.x

Loubert C, Fernando R. Cesarean delivery in the obese parturient: Anesthetic considerations. Womens Health 2011; 7(2): 163-179. http://dx.doi.org/10.2217/whe.10.77

Juvin P, Ferre G, Merouche M, Vallot T, Desmonts JM. Gastric residue is not more copious in obese patients. Anesthes Analg 2001; 23: 1621-22. http://dx.doi.org/10.1097/00000539-200112000-00061

Barak N, Ehrenpreis ED, Harrison, JR, Sutrin MD. Gastroesophageal reflux disease in obesity, pathophysiological and therapeutic considerations. Obes Rev 2002; 3: 9-15. http://dx.doi.org/10.1046/j.1467-789X.2002.00049.x

Tanabi I, Drolet P, Donati F. Optimizing preoxygenation in adults. Can J Anesthes 2009; 56(6): 449-466. http://dx.doi.org/10.1007/s12630-009-9084-z

Chang AB. Physiologic changes of pregnancy. Chestnut DH, Editor. Obstetric anesthesia, principles and practice, Third Edition. Philadelphia: Elsevier Mosby 2004; pp. 15-36.

Veille JC, Hanson R. Obesity, pregnancy and left ventricular functioning during the third trimester. Am J Obstet Gynecol 1994; 171: 980-83. http://dx.doi.org/10.1016/0002-9378(94)90018-3

Vascan RC. Cardiac function and obesity. Heart 2003; 89: 127-1129.

Roofthooft E. Anesthesia for the morbidly parturient. Curr Opin Anesthesiol 2009; 22: 341-346. http://dx.doi.org/10.1097/ACO.0b013e328329a5b8

Naef RW III, Chauhan SP, Chevalier SP, Roberts WE, Meydrech EF, Morrison JC. Prediction of hemorrhage at cesarean delivery. Obstet Gynecol 1994; 83: 923-925. http://dx.doi.org/10.1097/00006250-199406000-00004

Sabire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Regan L, et al. Maternal obesity and pregnancy outcome: A study of 287, 215 pregnancies in London. Int J Obes Relat Metab Disorders 2001; 25(8): 1175-1182. http://dx.doi.org/10.1038/sj.ijo.0801670

King Edward Memorial Hospital. Clinical guidelines in the management of pregnancy and childbirth in women with a body mass index above 40. Western Australia: King Edward Memorial Hospital Women and Newborn Health Services 2013.

Kobayashi N, Lim Boon H. Induction of labour and intrapartum care in obese women. Best Pract Res Clin Gastroenterol 2015; 29: 394-405. http://dx.doi.org/10.1016/j.bpobgyn.2014.07.024

Ray A, Haldreth A, Esen UI. Morbid obesity and intrapartum care. Journal of Obestrics and Gynecol April 2008; 28(3): 301-304. http://dx.doi.org/10.1080/01443610802042548

Alexander CL, Liston WA. Operating on the obese woman— A review. BJOG 2006; 113(10): 1167-1172.

Thornton YS. Cesarean delivery and celiotomy using panniculus retraction in the morbidly obese patient. J Am Coll Surg 2001; 193(4): 458-61. http://dx.doi.org/10.1016/S1072-7515(01)01023-7

Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complication of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203(3): 271 el-271.e7.

Wall PD, Devoy EE, Glantz JC, Pressman EK. Vertical skin incisions and wound complications in the obese parturient. Obstet Gynecol 2003; 102(5pt 1): 952-956. http://dx.doi.org/10.1016/S0029-7844(03)00861-5

Small F, Gyte GML. Antibiotic prophylaxis vs. no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2010; (1): CD007482.

Edmuston LE, Krepel C, Kelly H, et al. Perioperative antibiotic prophylaxis in the gastric bypass patient. Do we achieve therapeutic levels? Surgery 2004; 136(4): 738-747.

Pevzner L, Swank M, Krepel C, Wing DA, Chan K, Edmuston LE JR. Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery. Obstet Gynecol 2011; 117(4); 877-882.

Chelmow D, Rodriguez EJ, Sabatina MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: A metaanalysis. Obstet Gynecol 2004; 103(5 pt 1): 974-980. http://dx.doi.org/10.1097/01.AOG.0000124807.76451.47

ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 2007; 110(2 Pt 1): 429-440.

Duhl AJ, Paidas MJ, Ural SH, Branch W, Casele H, Cox-Gill J, et al. Pregnancy and thrombosis working group: antithrombotic therapy and pregnancy consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. Am J Obstet Gynecol 2007; 197(5): 457-21. http://dx.doi.org/10.1016/j.ajog.2007.04.022

Unterborn J. Pulmonary function testing in obesity. pregnancy and extremes of body habitus. Clinical Obstet Med 2001; (22): 759-767.

Gross JB, Bachenberg KL, Benumof JF. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology 2006; 9104: 1081-1093.

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Published

2015-12-31

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