Retos anestesiológicos y obstétricos de los partos por cesárea en obesas mórbidas. Estudio en el sudeste de Nigeria
Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria.
Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U.
Department of Anaesthesia, University of Nigeria, Enugu campus, Nigeria.uvkafor@yahoo.com
Afr Health Sci. 2012 Mar;12(1):54-7.
Abstract
BACKGROUND: Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. OBJECTIVE: To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. METHODS: The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). RESULTS: There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.
CONCLUSION: The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462507/pdf/AFHS1201-0054.pdf
Obesidad maternal y riesgo de evolución adversa del embarazo
Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome
Cedergren, Marie I. MD, PhD
Obstetrics & Gynecology February 2004 - Volume 103 - Issue 2 - pp 219-224
doi: 10.1097/01.AOG.0000107291.46159.00
OBJECTIVE: To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes. METHODS: In a prospective population-based cohort study, 3,480 women with morbid obesity, defined as a body mass index (BMI) more than 40, and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women (BMI 19.8-26). The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments. RESULTS: In the group of morbidly obese mothers (BMI greater than 40) as compared with the normal-weight mothers, there was an increased risk of the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (4.82; 4.04, 5.74), antepartum stillbirth (2.79; 1.94, 4.02), cesarean delivery (2.69; 2.49, 2.90), instrumental delivery (1.34; 1.16, 1.56), shoulder dystocia (3.14; 1.86, 5.31), meconium aspiration (2.85; 1.60, 5.07), fetal distress (2.52; 2.12, 2.99), early neonatal death (3.41; 2.07, 5.63), and large-for-gestational age (3.82; 3.50, 4.16). The associations were similar for women with BMIs between 35.1 and 40 but to a lesser degree.
CONCLUSION: Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions.
LEVEL OF EVIDENCE: II-2
http://journals.lww.com/greenjournal/Abstract/2004/02000/Maternal_
Morbid_Obesity_and_the_Risk_of_Adverse.2.aspx
Súper obesidad materna (IMC > o = 50) y evolución adversa del embarazo
Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes.
Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD.
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. alanis@musc.edu
Acta Obstet Gynecol Scand. 2010 Jul;89(7):924-30. doi: 10.3109/00016341003657884.
Abstract
OBJECTIVE: To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients. DESIGN: Cross-sectional study. SETTING AND POPULATION: All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database. METHODS: Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques. MAIN OUTCOME MEASURES: Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7. RESULTS: Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders. CONCLUSION: Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316123/pdf/nihms-363033.pdf
Obesidad y anestesia obstétrica.
OBSTETRIC ANAESTHESIA & OBESITY. ANAESTHESIA TUTORIAL OF THE WEEK 141. 6th JULY 2009
Dr Sally Ann Nortcliffe.
Consultant Anaesthetist, Manor Hospital, Walsall, West Midlands,
UK
http://www.frca.co.uk/Documents/141%20Obstetric%20anaesthesia%20and%20obesity.pdf
Obesidad en el embarazo
Obesity in Pregnancy
This Clinical Practice Guideline has been prepared by the Maternal Fetal Medicine Committee, reviewed by the Clinical Practice Obstetrics Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada
PRINCIPAL AUTHORS
Gregory A.L. Davies, MD, Kingston ON, Cynthia Maxwell, MD, Toronto ON, Lynne McLeod, MD, Halifax NS
http://www.sogc.org/guidelines/documents/gui239ECPG1002.pdf
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria.
Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U.
Department of Anaesthesia, University of Nigeria, Enugu campus, Nigeria.uvkafor@yahoo.com
Afr Health Sci. 2012 Mar;12(1):54-7.
Abstract
BACKGROUND: Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. OBJECTIVE: To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. METHODS: The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). RESULTS: There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.
CONCLUSION: The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462507/pdf/AFHS1201-0054.pdf
Obesidad maternal y riesgo de evolución adversa del embarazo
Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome
Cedergren, Marie I. MD, PhD
Obstetrics & Gynecology February 2004 - Volume 103 - Issue 2 - pp 219-224
doi: 10.1097/01.AOG.0000107291.46159.00
OBJECTIVE: To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes. METHODS: In a prospective population-based cohort study, 3,480 women with morbid obesity, defined as a body mass index (BMI) more than 40, and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women (BMI 19.8-26). The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments. RESULTS: In the group of morbidly obese mothers (BMI greater than 40) as compared with the normal-weight mothers, there was an increased risk of the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (4.82; 4.04, 5.74), antepartum stillbirth (2.79; 1.94, 4.02), cesarean delivery (2.69; 2.49, 2.90), instrumental delivery (1.34; 1.16, 1.56), shoulder dystocia (3.14; 1.86, 5.31), meconium aspiration (2.85; 1.60, 5.07), fetal distress (2.52; 2.12, 2.99), early neonatal death (3.41; 2.07, 5.63), and large-for-gestational age (3.82; 3.50, 4.16). The associations were similar for women with BMIs between 35.1 and 40 but to a lesser degree.
CONCLUSION: Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions.
LEVEL OF EVIDENCE: II-2
http://journals.lww.com/greenjournal/Abstract/2004/02000/Maternal_
Morbid_Obesity_and_the_Risk_of_Adverse.2.aspx
Súper obesidad materna (IMC > o = 50) y evolución adversa del embarazo
Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes.
Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD.
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. alanis@musc.edu
Acta Obstet Gynecol Scand. 2010 Jul;89(7):924-30. doi: 10.3109/00016341003657884.
Abstract
OBJECTIVE: To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients. DESIGN: Cross-sectional study. SETTING AND POPULATION: All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database. METHODS: Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques. MAIN OUTCOME MEASURES: Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7. RESULTS: Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders. CONCLUSION: Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316123/pdf/nihms-363033.pdf
Obesidad y anestesia obstétrica.
OBSTETRIC ANAESTHESIA & OBESITY. ANAESTHESIA TUTORIAL OF THE WEEK 141. 6th JULY 2009
Dr Sally Ann Nortcliffe.
Consultant Anaesthetist, Manor Hospital, Walsall, West Midlands,
UK
http://www.frca.co.uk/Documents/141%20Obstetric%20anaesthesia%20and%20obesity.pdf
Obesidad en el embarazo
Obesity in Pregnancy
This Clinical Practice Guideline has been prepared by the Maternal Fetal Medicine Committee, reviewed by the Clinical Practice Obstetrics Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada
PRINCIPAL AUTHORS
Gregory A.L. Davies, MD, Kingston ON, Cynthia Maxwell, MD, Toronto ON, Lynne McLeod, MD, Halifax NS
http://www.sogc.org/guidelines/documents/gui239ECPG1002.pdf
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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