The challenges of obesity and obstetric anaesthesia

The aim of this article is to review the clinical challenges of obesity in obstetrics from the anaesthetist's viewpoint.

The prevalence of obesity continues to increase both in the community and on the labour ward. Women who have undergone bariatric surgery are also on rise. During pregnancy, obesity is associated with hypertensive disease (chronic hypertension and preeclampsia), diabetes mellitus (pregestational and gestational), respiratory disorders (asthma and sleep apnoea), thromboembolic disease, caesarean section and infections (primarily urinary tract infections, wound infections and endometritis). Obesity is a risk factor for anaesthesia-related maternal mortality. Obese women are not only at high-risk of airway complications, cardiopulmonary dysfunction, perioperative morbidity and mortality but also pose technical challenges. Obesity also influences the fetal outcomes. Increasing use of regional techniques contributes to the reduced anaesthesia-related maternal mortality. Preconception counselling, antenatal screening and anaesthetic assessment are strongly encouraged.

Effective communication and good teamwork between an anaesthetist and an obstetrician are essential for the care of obese parturients. A more liberalized use of regional techniques may be a means of further reducing the anaesthesia-related maternal mortality.