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Anesthetic and Obstetric Outcome in Morbidly Obese Parturients: A Twenty Year Update
Abstract Number: S 27
Abstract Type: Original Research
Background:In 1993, Hood and Dewan published a large trial comparing obstetric and anesthetic outcomes of 117 morbidly obese (MO) parturients with matched controls (Anesthesiology 1993; 79:1210-8). The authors demonstrated a higher initial epidural anesthesia failure rate, as well as increased risk of obstetric complications and need for cesarean delivery (CD). Their results highlighted the importance of early epidural catheter placement with frequent assessment in MO parturients. The prevalence of obesity has increased dramatically during the past two decades. In theory, medical personnel have become more accustomed to the unique challenges of MO patients, including specialized equipment and skills with regional placement. We attempted to replicate the previous study to provide updated information on obstetric and anesthetic outcomes in the MO pregnant population.
Methods:Following IRB approval, the medical records of patients weighing > 300lbs (136.4kg) were retrospectively reviewed and compared to matched controls (next patient delivered by the same obstetrician with a weight <250lbs (113.6kg). To date, records have been retrieved for 9/24 months planned from 2011-12. T-tests and chi-square were used as appropriate (p<0.05 significant).
Results:42% of 96 MO women required CD compared to 26% of controls (see Table). MO patients had significantly longer stage 1 labors and larger neonates. As expected, MO parturients were more likely to have a failed initial regional technique for labor analgesia. However, failure rates of regional anesthesia for CD were similar between groups. The CSE technique was more commonly used for CD in MO patients without an existing epidural. The overall regional procedure time was greater in MO parturients compared to controls.
Discussion:MO women continue to have larger neonates, higher rates of CD, and are also more likely to have failed initial neuraxial techniques for labor analgesia. Labor curves may also look substantially different in this population. Compared to twenty years ago, the CSE technique is now used commonly for surgical anesthesia in MO parturients. This practice change likely reflects anticipated ease of initial placement, rather than ability to extend analgesia, as surgical times did not differ between groups. Despite 20 years of additional experience and technological advances, pregnant patients weighing greater than 300 pounds continue to be at increased risk of obstetric and anesthetic complications