Operative considerations in the obese pregnant patient

Many obstetricians feel that obesity is associated with a general increase in risks during pregnancy. However, there is some suggestion that obese patients may actually have a decreased risk of premature delivery and delivering small-for-gestational-age infants. Multiple studies have found that even though maternal medical complications are more likely in obese mothers, neonatal outcome can still be excellent in this group. Earlier reports found that the obese mother was at greater risk of abnormal labor and operative delivery. However, recent studies in which nonobese patients have been used as a control group have not found massively obese mothers to be at greater risk of labor abnormalities. Cesarean sections are more common in the overweight mother. The increase in cesarean birth is most likely due to an increase in previous abdominal delivery performed because of increased maternal diabetes and hypertension. Primary cesarean section due to cephalopelvic disproportion does not appear to be increased. When cesarean section is necessary in the massively obese patient, there is clearly an increase in operative morbidity and mortality. The guidelines listed in this article can be instituted best by obstetricians and anesthesiologists experienced in treating massively obese patients. By implementing this special care without undue delay when abdominal delivery is indicated, hopefully maternal and neonatal outcome can be optimized.