Saravanakumar K, Rao S G, Cooper G M
Department of Anaesthetics, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK.
Anaesthesia. 2006 Jan;61(1):36-48. doi: 10.1111/j.1365-2044.2005.04433.x.
The prevalence of obesity continues to increase despite preventive strategies. Obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases such as pre-eclampsia and gestational diabetes. Moreover, they have a tendency to labour abnormally contributing to increased instrumental delivery and Caesarean section. Obesity is a risk factor for anaesthesia related maternal mortality. Morbidly obese women must be considered as high-risk and deserve an anaesthetic consultation during their antenatal care. The significant difficulty in administering epidural analgesia should not preclude their use in labour. A more liberalised use of regional techniques may be a means to further reduce anaesthesia-related maternal mortality in the obese population. The mother's life should not be jeopardised to save a compromised fetus. Prophylactic placement of an epidural catheter when not contraindicated in labouring morbidly obese women would potentially decrease anaesthetic and perinatal complications associated with attempts at emergency provision of regional or general anaesthesia. Early mobilisation, aggressive chest physiotherapy and adequate pain control are essential components of effective postoperative care.
尽管采取了预防策略，但肥胖的患病率仍在持续上升。肥胖产妇并发内科疾病或出现如子痫前期和妊娠期糖尿病等叠加的产前疾病的风险增加。此外，她们往往产程异常，导致器械助产和剖宫产的增加。肥胖是与麻醉相关的孕产妇死亡的一个危险因素。病态肥胖女性必须被视为高危人群，在产前护理期间应接受麻醉咨询。硬膜外镇痛给药存在的显著困难不应妨碍其在分娩中的使用。更广泛地使用区域技术可能是进一步降低肥胖人群中与麻醉相关的孕产妇死亡率的一种方法。不应为了挽救受损胎儿而危及母亲的生命。在无禁忌证的情况下，为病态肥胖产妇预防性放置硬膜外导管可能会减少与紧急实施区域麻醉或全身麻醉相关的麻醉和围产期并发症。早期活动、积极的胸部物理治疗和充分的疼痛控制是有效术后护理的重要组成部分。
