Maternal and Fetal Outcomes With Early Neuraxial Engagement in Obese Parturients

Research indicates the combination of obesity and pregnancy is correlated with increased morbidity, mortality, and healthcare costs. The clinical inquiry of this study was: Does early neuraxial placement in obese parturients decrease the rate of cesarean delivery, decrease use of general anesthesia, and improve fetal Apgar scores? A retrospective analysis of 212 obese parturients with neuraxial anesthesia based on cervical dilation at time of placement and low-intervention delivery was conducted to evaluate the impact of early neuraxial intervention. The study site was a university-affiliated women and children's hospital in the US Midwest. Appropriate statistical analysis tests were performed to compare maternal and fetal outcomes of early, late, and no neuraxial anesthesia. Maternal outcomes included type of delivery, surgical anesthesia, and complications associated with the delivery. Fetal outcomes were Apgar scores and umbilical artery pH. Results of the retrospective analysis showed that early neuraxial placement was associated with a higher incidence of cesarean deliveries, successful conversion of laboring epidural to surgical epidural, avoidance of general anesthesia, potential loss of airway, and death. No significant differences were noted in Apgar scores based on neuraxial anesthesia timing. Further research regarding the risks and benefits of early neuraxial anesthesia in obese parturients is recommended.