Arch Gynecol Obstet. 2026 Apr 4;313(1):152. doi: 10.1007/s00404-026-08408-0.
ABSTRACT
BACKGROUND: Obesity affects nearly 40% of reproductive-aged American women, with over 12% classified as severely obese. Higher maternal body mass index (BMI) is linked to increased cesarean rates; however, data on intraoperative hemodynamics and anesthetic management, particularly in the superobese (BMI ≥ 50 kg/m2), remain limited.
METHODS: We conducted a retrospective cohort study of 2051 cesarean deliveries under neuraxial anesthesia, stratified by six BMI categories. The primary outcome was intraoperative hypotension based on serial noninvasive blood pressure (NIBP) readings. Secondary outcomes included neuraxial placement time, surgical duration, estimated blood loss (EBL), and neonatal Apgar scores. Multivariate regression, adjusted for comorbidities and neuraxial technique, assessed associations and outcome differences across BMI groups.
RESULTS: Superobese parturients exhibited a delayed yet sustained decline in mean arterial pressure (MAP) following neuraxial anesthesia, showing a late-phase, vasopressor-resistant hypotensive pattern. Time from surgical procedure start to fetal delivery increased from 11.8 ± 9.1 min in normal weight versus 17.3 ± 9.3 min in superobese (p < 0.0001). Between BMI groups, anesthesia start to procedure start, which reflected positioning, IV optimization, and neuraxial placement, increased from 35.1 ± 9.4 min to 50.6 ± 15.9 min (p < 0.0001), while total procedure time increased from 57.7 ± 24.3 to 76.8 ± 27.4 min (p < 0.0001). EBL was significantly higher in the superobese patients: 902 ± 294 mL versus normal BMI patients: 712 ± 230 mL (p < 0.0001). 1-min Apgar scores declined with higher BMI, but 5-min scores were comparable across groups.
CONCLUSIONS: Superobesity is associated with specific intraoperative negative outcomes during cesarean delivery under neuraxial anesthesia. Our study findings highlight the need for anticipatory anesthetic planning and tailored hemodynamic management strategies in high-BMI parturients to optimize maternal and neonatal outcomes.
PMID:41934472 | DOI:10.1007/s00404-026-08408-0
