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Obstetric, Anesthetic, and Neonatal Outcomes Among Super-Obese Parturients:
Abstract Number: F-60
Abstract Type: Original Research
Introduction: Obesity has become a worldwide epidemic, reflected in an increased prevalence in women of reproductive age.1 Between 1986 and 2000, the prevalence of super obese (BMI > 50) U.S. adults increased five-fold.2 There is an increased risk of adverse outcomes in obese parturients, but limited data exist regarding the super-obese obstetric population.3 The aim of our investigation was to review anesthetic outcomes in super-obese parturients, and to compare them to their obese and non-obese counterparts.
Methods: In this IRB-approved study we used the Perinatal Database at the University of Chicago to identify all super obese (BMI > 50), obese (BMI > 30 and < 50) and non-obese (BMI < 30) parturients who delivered during the years 2011- 2013. Data gathered included medical history, obstetric, anesthetic, and neonatal outcomes. We compared super-obese to obese and non-obese cohorts. Nominal data were analyzed using the Chi2 or Fisher exact test, as appropriate. Continuous data were examined for normality and analyzed using the Kruskal-Wallis test and Mann Whitney U test. P < 0.05 rejects the null hypothesis.
Results: We identified 150 super-obese, 2381 obese, and 2157 non-obese parturients. Demographics, comorbidities, and obstetric outcomes are in Table 1. Super-obese patients had higher BMI and age, and more diabetes (DM) and hypertension (HTN) than both cohorts. Obstetric outcomes demonstrated that super-obese had higher rates of cesarean delivery (CD) and operative vaginal delivery, and greater estimated blood loss (EBL) and hemorrhage compared to both cohorts; a higher rate of IUGR compared to the obese; and a higher rate of failed inductions requiring CD and longer labor duration compared to the non-obese. Infants of super-obese patients had lower arterial and venous pH and more NICU admissions than both cohorts. Ninety-three% of super-obese patients had anesthetic care; 4% received general anesthesia. The super-obese patients had an 8% rate of epidural catheter failure and a 5% rate of inadvertent dural puncture. There were no major airway complications.
Discussion: Super-obese patients have significantly more comorbidities and more peripartum and neonatal morbidity than obese and non-obese counterparts. Their anesthetic care is associated with acceptably low major complication rates.
1. World Health Organization Geneva (Switzerland) 2000.
2. Prachand VN et al.: Ann Surg. 2006;244:611–619
3. Hood DD, Dewan DM: Anesthesiol 1993;79:1210-8