Impact of morbid obesity on epidural anesthesia complications in labor

Objective We sought to determine whether morbid obesity is associated with increased maternal hypotension or fetal heart rate (FHR) abnormalities after epidural anesthesia placement during labor. Study Design This was a retrospective cohort study of women undergoing epidural anesthesia during labor at term from April 2008 through July 2010. Results A total of 125 morbidly obese patients were matched for age and race with 125 normal-weight patients. Morbidly obese patients had more frequent persistent systolic (16% vs 4%, P = .003) and diastolic (49% vs 29%, P = .002) hypotension and more prolonged (16% vs 5%, P = .006) and late (26% vs 14%, P = .03) FHR decelerations. Increasing body mass index was associated with persistent systolic (odds ratio, 1.06; 95% confidence interval, 1.02–1.10) and diastolic (odds ratio, 1.04; 95% confidence interval, 1.01–1.06) hypotension after controlling for epidural bolus dose and hypertensive disorders. Conclusion Morbidly obese women have more hypotension and prolonged FHR decelerations following epidural anesthesia during labor at term.