Pathophysiological and perioperative features of morbidly obese parturients

The prevalence of obesity is increasing among pregnant women. The association between obesity and pregnancy can result in further limitation of parturient physiological reserve. Indeed, maternal obesity is associated with an increased risk of delivery and postpartum complications, and poses a number of additional challenges for both general and neuroaxial anesthesia. The higher complication rate and the presence of obesity-related co-morbidities concur in placing this population at high risk for anesthesia-related maternal morbidity and mortality. Bariatric surgery scheduled before gestation to allow effective weight reduction, reduces the overall perinatal outcome to levels comparable to the general population. This review provides an insight into the magnitude and pathophysiological features of obese parturients, maternal and neonatal associated risks, along with peculiar anesthesiological management strategies.