Clinical obstetrics and gynecology
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The provision of anesthesia to the morbidly obese parturient is technically challenging. The anesthesia provider anticipates difficulty with intravenous access, positioning, monitoring, and placement of neuraxial anesthesia. ⋯ Among obese gravidas, there is a lower risk of the development of a headache from an accidental dural puncture, due not to the body habitus, but rather to the group's higher cesarean delivery rate. It is the process of bearing down during delivery that increases the chance of the development of a headache following dural puncture.
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Obesity in pregnancy confers morbidity to both the mother and neonate. Obese women are at increased risk of cesarean delivery, operative vaginal delivery, and failed trial of labor after cesarean delivery. ⋯ The risk of these complications increases with increasing maternal body mass index. In this chapter, we discuss evidence-based strategies to mitigate these risks and to manage complications that occur at the time of delivery in obese parturients.