Prevalence and Perioperative Complications of Super-obese Parturients Undergoing Cesarean Delivery

Background: Perioperative anesthetic and obstetric complications in morbidly obese patients have been extensively researched, revealing a greater incidence of complications compared to both obese and non-obese patients. This study aimed to determine the prevalence and perioperative complications specifically among super-obese parturients undergoing cesarean delivery. Method: This retrospective study used data from Thailand's largest university hospital from January 1, 2014, to January 31, 2023, including cesarean patients with a BMI > 50 kg/m² on the day of surgery. Patients with a gestational age < 24 weeks or incomplete anesthetic records were excluded. Results: Of 30,383 cesarean deliveries at our institute, 42 patients with a BMI > 50 kg/m² were analyzed, with a prevalence of 0.14% (95% CI: 0.10–0.19). The patients’ mean BMI was 55.9 ± 5.6 kg/m² (range: 50.7–75.2 kg/m²). Intraoperative hypotension occurred in 95.2% of cases, with 78.6% requiring vasopressors. Postpartum hemorrhage was diagnosed in 11.9% of patients. Three patients (7.1%) developed postoperative pulmonary edema requiring diuretics. A positive correlation was found between body weight and intraoperative blood loss (Pearson’s r = 0.588, p < 0.001). The logistic regression model predicted intraoperative blood loss as: 3669.62 – 51.52 (BW) + 0.21 (BW)²; R² = 0.425, F (2, 39) = 14.39, p < 0.001. Conclusion: A high rate of intraoperative hypotension, postpartum hemorrhage, and a moderate to high correlation between body weight and intraoperative blood loss were discovered in super-obese parturients undergoing cesarean delivery. Keywords: Cesarean delivery, Hemorrhage, Perioperative outcomes, Super-obesity