DALLAS, Oct 13 (Reuters Health) -- The more obese a pregnant woman is, the higher her risk of delivery by Cesarean section, a team of anesthesiologists report. Due to this risk, the research team recommends that obese pregnant women have an epidural anesthetic once they are in labor to minimize the risks of a general anesthetic should they require a surgical delivery.
"For obese pregnant patients, obstetricians should consider early labor epidural analgesia," said study lead author Dr. Elizabeth Bell of Duke University in Durham, North Carolina. She presented her group's findings here Wednesday at the annual meeting of the American Society of Anesthesiologists.
The Duke team reviewed data on the height and weight of nearly 2,500 pregnant women over a 16-month period. Women were divided into groups based on their body mass index (BMI) -- a standard computation of obesity that takes into account both weight and height. For example, a woman measuring 5'6" and weighing 185 pounds would have a BMI of 30. Individuals with BMIs of 30 and above are considered obese.
They found that nearly a third (833) of women delivered by Cesarean section. Among these women, the average body mass index was 53 (i.e., a 5'3" woman weighing 300 pounds). In contrast, the average BMI of women delivering vaginally was 31.
According to Bell, preliminary findings of another study of approximately 1,000 women found that women with a "BMI over 40 had twice the incidence of Cesarean section" than women with BMIs under 40. She told Reuters Health that the data "showed a clear relationship between BMI and risk for Cesarean section."
In a related study also presented in Dallas, Dr. Joy Hawkins reported that epidural anesthesia was used for Cesarean section in over 90% of the US hospitals surveyed in 1997. "The use of general anesthesia for Cesarean section has almost dropped off the map," she said.
Hawkins and colleagues from the University of Colorado School of Medicine in Denver surveyed the obstetric anesthesia practices in 750 hospitals nationwide.
They found that epidural anesthesia for labor was used in 33% of the hospitals overall. The 1997 data show that "more than 50% of women have some kind of (local) anesthesia for labor and delivery," Hawkins said.
"Hospitals are getting much better coverage for obstetrics, with anesthesia available even in the smallest hospital(s)," Hawkins told Reuters Health.
