1. Obesity and pregnancy Marjorie Meyer MD University of Vermont

2. Is obesity associated with an increase in pregnancy complications and cesarean delivery?

3. Usual suspects: diabetes, hypertension, preeclampsia, macrosomia, cesarean. Weiss, AJOG 2004 Cesarean nullip: control 20.7%; obese 33.8%, morbid obese 47.4%

4. VBAC success: predictably less with obesity 66% success overweight; 54% success obese Success: Lower BMI Smaller infants Spontaneous labor Durnwald, Am J Ob Gyn 2004

5. Management at cesarean delivery

6. Anesthesia Antenatal consult with anesthesia Increased use of regional analgesia Increased diffiuclty with regional placement: use of ultrasound Prepare for airway and/or ventilation problems

7. Wound infection prevention: prophylactic antibiotics helpful; no other compelling supporting data Hellums, AJOG 2007

8. Postpartum DVT prophylaxis until discharge –ICD –heparin

9. Overall plan for obese patients Screen for diabetes early and later Watch for hypertensive complications Watch fetal growth (clinically difficult to assess) Prepare for increased risk of cesarean delivery: anesthesia consult during pregnancy Use prophylactic antibiotics, although drain is not as helpful Use DVT prophylaxis, with ICD in the OR AMBULATE