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The obese parturient 

The obese parturient
Chapter:
The obese parturient
Author(s):

Fiona C. Denison

and Alistair Milne

DOI:
10.1093/med/9780198713333.003.0039
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date: 28 November 2020

Maternal obesity is the most common pre-existing morbidity in pregnant women in the United Kingdom. Obesity is associated with increased risk of maternal and offspring morbidity and mortality. Increased maternal morbidity is multifactorial. There is an increased incidence of coexisting medical conditions. Adverse physiological changes related to obesity also contribute to risk. In addition to this, there is an increased risk of many complications developing de novo during pregnancy. There are many practical and technical challenges for the multidisciplinary team that must be addressed in order to care for the morbidly obese parturient effectively. Many items of equipment designed for use with the morbidly obese will need to be available. Due to the complexity of their care and increased risks, all women with a body mass index over 40 kg/m2 should be seen prior to labour and delivery by an anaesthetist. This allows for timely planning of their care, involvement of appropriate personnel and equipment, and expectation management. The use of neuraxial analgesia and anaesthesia, whilst prone to increased technical difficulties and failure rates, has significant advantages for many morbidly obese parturients. There are many increased risks associated with general anaesthesia in the morbidly obese, but this may be the only option for operative delivery in some super morbidly obese parturients who cannot tolerate a tilted supine position. The care of the morbidly obese parturient is truly multidisciplinary which should be coordinated by a named consultant obstetrician.

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