Anesthetic implications of morbid obesity during pregnancy; a literature based review

Mossie, Addisu; Ahmed, Siraj; Tesema, Hailemariam Getachew

doi:10.1016/j.ijso.2022.100444

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…Multiparity, a history of diabetes mellitus (DM) and previous fetal macrosomia, gestational diabetes mellitus (GDM), obesity, gestational age of 40 weeks, and maternal age of 30-39 years have been associated with fetal macrosomia [3]. This is a challenging problem even for an experienced obstetrician as it adversely affects maternal and neonatal health [4].…”

Section: Introductionmentioning

confidence: 99%

Fetal Macrosomia Among Non-diabetic Women: Our Experience in a Developing Country

Shafqat¹,

Zeb²,

Yasmin³

2022

Cureus

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BackgroundThe prevalence of fetal macrosomia varies worldwide. Its trend has increased over the past decades in many developed nations. It is associated with various maternal and fetal complications. The information regarding the frequency of fetal macrosomia among non-diabetic women is limited in resource-limited countries such as Pakistan. Therefore, this study aimed to determine the number of fetal macrosomia cases among nondiabetic women. MethodologyThis was a cross-sectional study conducted in a tertiary care hospital in Peshawar, Pakistan. A total of 119 pregnant women were enrolled in the study. All pregnant women aged 15 to 45 years who had singleton pregnancies with any parity or gravida and a gestational age of ≥37 weeks were included in the study. Pregnant women with underlying chronic systemic disorders such as diabetes mellitus, gestational diabetes mellitus, hypertension, renal or cardiac disorders, and sickle cell anemia were excluded from the study. Women who did not consent to participate and those with a gestational age of ≥42 weeks at the time of delivery were also excluded from our study. Based on a 5.2% prevalence of fetal macrosomia in the general population, the sample size was calculated using the World Health Organization calculator at a confidence interval of 95%, absolute precision of 0.05 with anticipated population proportion, and a 4% margin of error. The required sample size was calculated at 119. The chi-square test was applied. P-values of ≤0.05 were considered significant. ResultsOut of 119 participants, fetal macrosomia among non-diabetic women was seen in 10 (8.4%) cases. The mean age of patients in our study was 29.80 ± 4.33 years. The mean gestational age was 36.05 ± 1.31 weeks, whereas the mean body mass index of participants was 29.17 ± 2.36 kg/m 2 . Post-stratification, spontaneous vaginal delivery was the only significant variable with a P-value of <0.05 in our study. ConclusionsThe number of fetal macrosomia among non-diabetic women in our study was 10 (8.4%). Because this was a single-center, hospital-based, cross-sectional study, we need to conduct large multi-centered randomized controlled studies to identify the actual prevalence of fetal macrosomia in non-diabetic women in our population.

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Section: Introductionmentioning

confidence: 99%

Fetal Macrosomia Among Non-diabetic Women: Our Experience in a Developing Country

Shafqat¹,

Zeb²,

Yasmin³

2022

Cureus

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Challenges of morbid obesity in gynecological practice

Opoku.

Onifade

Odukoya

2023

Best Practice & Research Clinical Obstetrics & Gynaecol

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Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study

de Vries,

Verspyck,

Morau

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionObstetric hemorrhage remains a largely preventable cause of maternal mortality globally. The contribution of uterine atony to hemorrhage‐related maternal mortality has decreased in France, while the contribution of other causes of obstetric hemorrhage such as surgical injury during cesarean has been reported to increase. However, little evidence exists regarding the risk factors and care processes of women who died from this cause of hemorrhage. Therefore, we aimed to describe the clinical profile, underlying mechanisms, and preventability factors among women who died from obstetric hemorrhage by surgical injury during cesarean section.Material and MethodsNationwide analysis of all hemorrhage‐related maternal deaths by surgical injury during cesarean in France identified by the nationwide permanent enhanced maternal mortality surveillance system (ENCMM) between 2007 and 2018. We described the characteristics of the women, delivery hospitals, circumstances of hemorrhage, features of obstetric and resuscitation/transfusion care, and main preventability factors.ResultsBetween 2007 and 2018, hemorrhage‐related maternal mortality in France decreased from 1.6/100 000 live births (95% CI 1.1–2.2) (39/2 472 650) in 2007–2009 to 0.8/100 000 live births (95% CI 0.5–1.3) (19/2 311 783) in 2016–2018. Hemorrhage‐related maternal mortality ratio due to surgical injury during cesarean increased from 0.08 (95% CI 0.01–0.3) (2/2 472 650) to 0.2 (95% CI 0.07–0.5) (5/2 311 783) per 100 000 live births. Among the 18 women who died from surgical injury during cesarean over the 12‐year study period, we report a high prevalence of obesity (67%, 12/18), previous cesarean (72%, 13/18), and second‐stage cesareans (56%, 10/18). In 22% (4/18), cesarean section was performed in a hospital providing <1000 births annually, with no blood bank (39%, 7/18) or no adult intensive care (44%, 8/18) on‐site. Overall preventability of deaths was 94% (17/18). Main preventability factors were related to delay in hemorrhage diagnosis (77%, 14/18) due to late recognition of abnormal parameters (33%, 6/18) and late bedside ultrasound (56%, 10/18), and delay in management due to insufficient surgical skills (56%, 10/18).ConclusionsIn France, surgical injury during cesarean section is an increasing, largely preventable contributor to hemorrhage‐related maternal mortality, as other causes of fatal hemorrhage have become less frequent. The profile of these women showed a high prevalence of obesity, previous cesarean, second‐stage cesarean, and delivery in hospitals with limited medical and surgical resources, which suggests explanatory mechanisms for the fatal outcome and opportunities for prevention.

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Anesthetic implications of morbid obesity during pregnancy; a literature based review

Cited by 3 publications

References 47 publications

Fetal Macrosomia Among Non-diabetic Women: Our Experience in a Developing Country

Fetal Macrosomia Among Non-diabetic Women: Our Experience in a Developing Country

Challenges of morbid obesity in gynecological practice

Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study

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