From the Guidelines
Cesarean deliveries in women with a BMI over 40 often require specialized equipment to ensure safe and effective surgical outcomes. According to the most recent and highest quality study, 1, operating room staff should be alerted regarding any woman whose weight exceeds 120 kg to ensure that adequate staffing and equipment are available. This is crucial because standard operating room equipment may be inadequate for patients with higher BMIs, potentially compromising surgical access, patient safety, and procedural outcomes.
Specialized Equipment Needed
Some of the specialized equipment that may be required for cesarean deliveries in women with a BMI over 40 include:
- Operating tables with higher weight capacities (typically 500-1000 pounds)
- Longer surgical instruments, including retractors and tissue forceps
- Wider and longer speculums for proper visualization
- Bariatric blood pressure cuffs for accurate monitoring
- Specialized positioning aids like wider stirrups and additional personnel for safe patient transfers
- Extra-long spinal and epidural needles for anesthesia administration
Importance of Specialized Equipment
The use of specialized equipment is essential to reduce the risk of complications during cesarean deliveries in women with a BMI over 40. As noted in 1, the peri-operative management of obese surgical patients requires careful planning and attention to detail to ensure safe and effective outcomes. The use of specialized equipment can help to minimize the risk of surgical site infections, wound complications, and other post-operative complications.
Institutional Protocols
Institutions that regularly care for patients with obesity should develop patient safety bundles with institutional protocols for cesarean deliveries, including the use of specialized equipment and staffing, as recommended in 1 and 1. This can help to ensure that patients receive optimal care and reduce the risk of complications during cesarean deliveries. The use of specialized equipment and institutional protocols can help to improve patient outcomes and reduce morbidity and mortality associated with cesarean deliveries in women with a BMI over 40.
From the Research
Cesarean Deliveries in Obese Women
- Cesarean deliveries in obese women with a Body Mass Index (BMI) over 40 may require specialized equipment and careful planning due to the increased risk of complications 2, 3.
- The risk of cesarean delivery is increased in obese parturients, and obesity is associated with increased comorbidities and maternal, fetal, and neonatal complications 2, 4.
- Studies suggest that nulliparity, height, initial cervical dilation, and modified Bishop score are associated with a higher rate of cesarean delivery in obese women 4, 5.
Specialized Equipment and Care
- Anesthetic management of the obese parturient is challenging and requires adequate planning, including the use of specialized equipment and techniques 2.
- Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients, but can be technically challenging 2.
- Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status 2.
Complications and Risks
- 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, 6.
- The risk of intraoperative complications does not appear to be increased in obese women, even among those with super obesity 6.
- Maternal age, induced labor, and the use of oxytocin during labor are positively associated with cesarean delivery in obese nulliparous women 5.