• Laura K Vricella, Judette M Louis, Brian M Mercer, and Norman Bolden.
• Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
• Am. J. Obstet. Gynecol. 2010 Sep 1;203(3):276.e1-5.

ObjectiveWe sought to estimate the morbidity associated with regional anesthesia in morbidly obese women undergoing scheduled cesarean delivery.Study DesignThis was a retrospective cohort study of women undergoing elective scheduled cesarean delivery from September 2004 through December 2008.ResultsA total of 142 morbidly obese, 251 overweight and obese, and 185 normal-weight women met inclusion criteria. Differences between groups were identified regarding: complicated placement (5.6%, 2.8%, and 0%, respectively; P = .007), failure to establish (2%, 0%, and 0%, respectively; P = .047), and insufficient duration (4%, 0%, and 0%, respectively; P = .02) of regional anesthesia. The groups differed in the frequency of general anesthesia (6%, 0%, and 0%, respectively; P = .003), intraoperative hypotension (3%, 0%, and 0%, respectively; P = .01), and overall anesthetic complications (8.4%, 0%, and 0%, respectively; P < .0001). Prepregnancy body mass index > or = 40 kg/m(2) (receiver operating characteristic area under the curve, 0.856; positive likelihood ratio, 4.0) and delivery body mass index > or = 45 kg/m(2) (receiver operating characteristic area under the curve, 0.877; positive likelihood ratio, 4.1) were predictive of anesthetic complications.ConclusionMorbidly obese women have significant risk for anesthesia complications during cesarean delivery.Copyright 2010 Mosby, Inc. All rights reserved.

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