Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m⁻²

Abstract

An increasing number of women with a body mass index (BMI) ≥ 60 kg m−2, referred to as super-super obesity, are requiring anesthetic care for labor and delivery. Management of these patients presents obstetric, anesthetic, and logistical challenges. We report our experience in the management of cesarean delivery in a parturient with a BMI of 112 kg m−2. Use of epidural anesthesia and performance of a supraumbilical transverse surgical incision with caudal placement of the panniculus resulted in optimal hemodynamic and ventilatory parameters. Effective multidisciplinary planning and communication is key. We present this case to highlight decision-making strategies and elucidate our approach in the management of this complex obstetric case.

Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist

“…Surgical plan for type of incision and position of the panniculus should be confirmed preoperatively. Availability of non-invasive ventilation, difficult airway equipment, specialized bariatric equipment and ultrasonography is part of preanesthetic planning for these cases [ 68 ].…”