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...

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Veröffentlicht in:American journal of obstetrics and gynecology 2011-10, Vol.205 (4), p.370.e1-370.e6
Hauptverfasser: Vricella, Laura K., MD, Louis, Judette M., MD, MPH, Mercer, Brian M., MD, Bolden, Norman, MD
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container_issue 4
container_start_page 370.e1
container_title American journal of obstetrics and gynecology
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creator Vricella, Laura K., MD
Louis, Judette M., MD, MPH
Mercer, Brian M., MD
Bolden, Norman, MD
description 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.
doi_str_mv 10.1016/j.ajog.2011.06.085
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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.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2011.06.085</identifier><identifier>PMID: 21864821</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Anesthesia ; Anesthesia, Epidural - adverse effects ; Anesthesia, Obstetrical - adverse effects ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cohort Studies ; complications ; Delivery. Postpartum. Lactation ; epidural ; Female ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Gynecology. Andrology. Obstetrics ; Heart Rate, Fetal ; Humans ; hypotension ; Hypotension - etiology ; Medical sciences ; Metabolic diseases ; morbid obesity ; Obesity ; Obesity, Morbid - complications ; obstetric anesthesia ; Obstetric Labor Complications - etiology ; Obstetrics and Gynecology ; Pregnancy ; Retrospective Studies ; Young Adult</subject><ispartof>American journal of obstetrics and gynecology, 2011-10, Vol.205 (4), p.370.e1-370.e6</ispartof><rights>Mosby, Inc.</rights><rights>2011 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Mosby, Inc. 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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.</description><subject>Adult</subject><subject>Anesthesia</subject><subject>Anesthesia, Epidural - adverse effects</subject><subject>Anesthesia, Obstetrical - adverse effects</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>complications</subject><subject>Delivery. Postpartum. Lactation</subject><subject>epidural</subject><subject>Female</subject><subject>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Heart Rate, Fetal</subject><subject>Humans</subject><subject>hypotension</subject><subject>Hypotension - etiology</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>morbid obesity</subject><subject>Obesity</subject><subject>Obesity, Morbid - complications</subject><subject>obstetric anesthesia</subject><subject>Obstetric Labor Complications - etiology</subject><subject>Obstetrics and Gynecology</subject><subject>Pregnancy</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2L1TAUhoMoznX0D7iQbMRV60nSfBREGAZnHBhw4exDmqSa2jY1aYX77025V4VZuAonPO_h5TkIvSZQEyDi_VCbIX6rKRBSg6hB8SfoQKCVlVBCPUUHAKBVy6S6QC9yHvaRtvQ5uqBEiUZRckA3d9Ni7Ipjj6eYuuBw7HwO6xHHGfsluC2ZEZvZ5_V7-TfYxmkZgzVriHPGYcaj6WJ6iZ71Zsz-1fm9RA83nx6uP1f3X27vrq_uK9uoZq1E66jjvuW9VV3fKGYc7TuuGPdSWC-5IOAps43jlhkhQXaCtyAdY9xKwi7Ru9PaJcWfW-mkp5CtH8dSMG5Zt9BQyngDhaQn0qaYc_K9XlKYTDpqAnq3pwe929O7PQ1CF3sl9Oa8fusm7_5G_ugqwNszYLI1Y5_MbEP-x3GqCGWqcB9OnC8ufgWfdLbBz9a7kLxdtYvh_z0-PorbMcxF-vjDH30e4pbmYlkTnakG_XU_7H5mQgAUY5L9BmrtocI</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Vricella, Laura K., MD</creator><creator>Louis, Judette M., MD, MPH</creator><creator>Mercer, Brian M., MD</creator><creator>Bolden, Norman, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Impact of morbid obesity on epidural anesthesia complications in labor</title><author>Vricella, Laura K., MD ; Louis, Judette M., MD, MPH ; Mercer, Brian M., MD ; Bolden, Norman, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-69d2d5e95fc8bf483ad2fb5835e76ce75610e23c4d5c3a6707b65907d335c713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Anesthesia</topic><topic>Anesthesia, Epidural - adverse effects</topic><topic>Anesthesia, Obstetrical - adverse effects</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>complications</topic><topic>Delivery. Postpartum. Lactation</topic><topic>epidural</topic><topic>Female</topic><topic>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</topic><topic>Gynecology. Andrology. 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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. 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subjects Adult
Anesthesia
Anesthesia, Epidural - adverse effects
Anesthesia, Obstetrical - adverse effects
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cohort Studies
complications
Delivery. Postpartum. Lactation
epidural
Female
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Gynecology. Andrology. Obstetrics
Heart Rate, Fetal
Humans
hypotension
Hypotension - etiology
Medical sciences
Metabolic diseases
morbid obesity
Obesity
Obesity, Morbid - complications
obstetric anesthesia
Obstetric Labor Complications - etiology
Obstetrics and Gynecology
Pregnancy
Retrospective Studies
Young Adult
title Impact of morbid obesity on epidural anesthesia complications in labor
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