From the Guidelines
Obesity is a significant risk factor for maternal mortality after a cesarean section, particularly for women with a BMI over 30. According to the guidelines for the management of pregnant women with obesity, a systematic review published in 2020 in Obesity Reviews 1, women with a BMI ≥30 are at increased risk of postpartum haemorrhage and should have active management of the third stage of labour.
The review also notes that obesity alone is not an indication for elective C-section, but the operative and anaesthetic risks of emergency C-section are higher for women with obesity 1. This highlights the need for careful planning and management of cesarean deliveries in obese women.
Some key recommendations for reducing the risk of complications in obese women undergoing cesarean sections include:
- Early establishment of venous access during labour for women with a BMI above 40
- Suturing of the subcutaneous tissue space to reduce the risk of wound infection and wound separation in women with more than 2 cm of subcutaneous fat
- Mechanical thromboprophylaxis using pneumatic compression devices before and after C-section, as well as weight-based dosing of pharmacologic options for thromboprophylaxis 1
These measures can help reduce the risk of maternal mortality in obese women undergoing cesarean sections. It is essential for healthcare providers to be aware of these risks and take proactive steps to mitigate them, including close postoperative monitoring and specialized surgical techniques.
From the Research
Obesity as a Risk Factor for Maternal Mortality after Cesarean Section
- Obesity is a significant risk factor for complications during pregnancy and cesarean procedures 2, 3, 4, 5, 6.
- Studies have shown that morbidly obese women with a body mass index (BMI >40 kg/m²) are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery 2.
- The risk of maternal death increases with BMI, with overweight women having an adjusted odds ratio of death of 1.65, women with class 1 obesity having an adjusted odds ratio of 2.22, and those with class 2-3 obesity having an adjusted odds ratio of 3.40 6.
Complications Associated with Cesarean Delivery in Obese Women
- Obese women are at increased risk of cesarean delivery-related complications, including anesthetic complications, wound complications, venous thromboembolism (VTE), and failure of vaginal birth after cesarean delivery 3.
- Surgical site infections, yeast infections, and seroma are also more common in obese women after cesarean delivery 4.
- Closure of the subcutaneous tissue and avoidance of subcutaneous drains can reduce the incidence of wound complications associated with cesarean section in obese patients 5.
Management and Prevention of Complications
- Appropriate dose of prophylactic antibiotics, closure of the subcutaneous tissue, and avoidance of subcutaneous drains can reduce the incidence of wound complications associated with cesarean section in obese patients 5.
- Training clinicians in the specificities of care for pregnant women with obesity could improve their outcomes 6.
- Suboptimal care was found to be as frequent among women with as without obesity, but inadequate management was directly related to obesity in a significant proportion of cases 6.