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 |
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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. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-69d2d5e95fc8bf483ad2fb5835e76ce75610e23c4d5c3a6707b65907d335c713</citedby><cites>FETCH-LOGICAL-c484t-69d2d5e95fc8bf483ad2fb5835e76ce75610e23c4d5c3a6707b65907d335c713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937811008337$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,3537,23909,23910,25118,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25281238$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21864821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vricella, Laura K., MD</creatorcontrib><creatorcontrib>Louis, Judette M., MD, MPH</creatorcontrib><creatorcontrib>Mercer, Brian M., MD</creatorcontrib><creatorcontrib>Bolden, Norman, MD</creatorcontrib><title>Impact of morbid obesity on epidural anesthesia complications in labor</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><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.</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. Obstetrics</topic><topic>Heart Rate, Fetal</topic><topic>Humans</topic><topic>hypotension</topic><topic>Hypotension - etiology</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>morbid obesity</topic><topic>Obesity</topic><topic>Obesity, Morbid - complications</topic><topic>obstetric anesthesia</topic><topic>Obstetric Labor Complications - etiology</topic><topic>Obstetrics and Gynecology</topic><topic>Pregnancy</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vricella, Laura K., MD</creatorcontrib><creatorcontrib>Louis, Judette M., MD, MPH</creatorcontrib><creatorcontrib>Mercer, Brian M., MD</creatorcontrib><creatorcontrib>Bolden, Norman, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vricella, Laura K., MD</au><au>Louis, Judette M., MD, MPH</au><au>Mercer, Brian M., MD</au><au>Bolden, Norman, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of morbid obesity on epidural anesthesia complications in labor</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>205</volume><issue>4</issue><spage>370.e1</spage><epage>370.e6</epage><pages>370.e1-370.e6</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>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.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21864821</pmid><doi>10.1016/j.ajog.2011.06.085</doi><tpages>2</tpages><oa>free_for_read</oa></addata></record> |
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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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