Guillermo Valenzuela

By Kristina Roloff, Suzanne Cao, Camille Okekpe, Inessa Dombrovsky and Guillermo Valenzuela

The obesity epidemic has touched all aspects of obstetric care, including the practice of cesarean delivery. Obesity is an independent risk factor for cesarean delivery, and the increased prevalence of obesity has contributed to the overall rise in primary cesarean delivery seen over the past few decades. Because of the frequent existence of co-morbidities such as hypertension and diabetes, obesity is a plausible contributor to rising maternal mortality. In addition, obese women who undergo both primary and repeat cesarean delivery have a higher chance to develop surgical and post-operative complications, including wound infection and thromboembolic events. Surgical complications increase steadily with increasing maternal weight. In this chapter, we will review the incidence and contributing factors that lead to cesarean delivery in obese patients, peri-operative complications, and strategies to reduce these risks in obese women undergoing cesarean delivery.

Part of the book: Recent Advances in Cesarean Delivery

By Tina Bui, Kristina Roloff and Guillermo Valenzuela

Obesity is an epidemic worldwide with about half of the population being classified as overweight and obese. Second stage labor arrest may occur more commonly in patients with obesity, leading to a higher number of cesarean deliveries. Second stage arrest is diagnosed based on a fixed time frame without consideration of the total amount of expulsive forces exerted. The beginning of the second stage of labor is determined by an arbitrary parameter that depends on the timing intervals at which patients are examined. In other words, the specific point at which the second stage begins (complete dilation) is influenced by the frequency of examinations conducted during labor. Therefore, it would be reasonable to consider factors such as the cumulative duration of pushing and/or the number of pushes and/or cumulative force generated as clinical measurements to determine the optimal length of the second stage of labor. By redefining the criteria used to define second stage labor dystocia or arrest, we can ensure that patients are given an appropriate amount of time to generate the expulsive forces necessary for a safe vaginal delivery. Here, we will review the evidence to help optimize the management of the second stage.

Part of the book: Childbirth