Maternal and Fetal Outcomes and Early Neuraxial Engagement in Obese Parturients
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Obesity has created challenges for healthcare consumers, providers, and healthcare institutions. The combination of obesity and pregnancy is correlated with increased morbidity, mortality, and healthcare costs. The clinical inquiry is, Does early neuraxial placement in obese parturients affect maternal and fetal outcomes? Review of 23 studies indicates a higher incidence of hypertension, preeclampsia, shoulder dystocia, hemorrhage, caesarean delivery, and failed intubations in the obese parturient. A retrospective analysis of 212 obese parturients with neuraxial analgesia, based on cervical dilation, evaluated the impact of early neuraxial placement. Comparison of early, late, and no neuraxial analgesia was conducted on the outcome variables of type of delivery (vaginal or caesarean), anesthetic (combined spinal-epidural, epidural, or general), pain scores, Apgar scores, and newborn umbilical artery pH. Additional adverse outcome variables were analyzed and included difficult CSE placement, shoulder dystocia, hemorrhage, fetal intolerance to labor, and NICU admissions. The results indicated decreased failure rate for epidurals (0.876%), lower numerical pain scores, and reduction in general anesthesia (0.9%), higher incidence of fetal intolerance (6.7%, p=0.012), and caesarean delivery in the early neuraxial group. Higher incidence of hemorrhage, (15%), shoulder dystocia (12%), and NICU admissions (8%, p= 0.014) were correlated with the no anesthetic group. Development of neuraxial guidelines and algorithms related to obese parturients could improve maternal and fetal outcomes, patient satisfaction, and reduce healthcare expenditures in the United States.
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