Serviço Ginecologia e Obstetricia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, E.P.E.
- 17th World Congress on Controversies in Obstetrics, Gynecology& Infertility.
Problem Statement: The right for the patient to be actively involved in treatment decisions, including method of delivery, is now widely accepted. Caesarean delivery (CD) on maternal request, performed because the mother prefers this route of delivery and not because a conventional medical or obstetrical indication, has risks and benefits. The available data suggests that planned CD has a lower risk of postpartum hemorrhage and fetal trauma, and minimizes the risk of surgical complications associated with unplanned cesarean during an attempt of vaginal delivery. However, it is also associated with longer hospital stay/recovery, an increased risk of neonatal respiratory problems and a greater risk of abnormal placentation in future pregnancies.
In obese pregnant, CD presents additional challenges: it´s associated with numerous perioperative risks, prolonged incision-to-delivery interval, blood loss >1000 mL, longer operative times, wound infection, thromboembolism and endometritis. In obese women with a body mass index (BMI) over 40 kg/m2, CD often requires modifications of equipment, anesthesia/analgesia and surgical technique to ensure an optimal outcome.
Case report: Pregnant, 24 years old, primigravida, with class III obesity – preconception BMI 49 Kg/m2 and asthma, referred to our Maternal-Fetal Department at 16 weeks of gestational age. During pregnancy her weight increased 12 Kg, there were neither acute asthmatic exacerbations nor major obstetric complications, however, because of her background, both pregnant and the assistant Pneumologyst asked for a CD.
After interdisciplinary discussion and explaining to the patient the risks and benefits of vaginal and CD, there was a consensus choice for a vaginal route. At 39 weeks, vacuum-assisted delivery, due to prolonged second stage of labor, resulted in a healthy female newborn with 2680g and Apgar score 9/10. A normal puerperium followed.
Conclusion: CD on maternal request has risks and benefits that must be thorough discussed in order for the pregnant to have an informed opinion. Information about pertinent childbirth issues and appropriate support usually overcomes most of their concerns about vaginal birth. In obese patients this discussion has major relevance because the increased surgical risks in these patients.
Keywords: obesity, caesarean delivery on maternal request.