The 30 minute decision to delivery time is unrealistic in morbidly obese women

Abstract

The worldwide incidence of obesity has increased dramatically over the last few years. Obesity is associated with increased morbidity and mortality, particularly related to cardiovascular disease and diabetes and this is reflected in the obese obstetric patient where maternal and neonatal morbidity are greater than in the non-obese parturient. Maternal obesity is recognised as one of the most commonly occurring risk factors seen in obstetrics; in the last CEMACH report more than half the women who died were obese. The World Health Organisation has stratified obesity into three levels (Table 1). Aside from the increased medical risks associated with obesity, the obese parturient is more likely to require medical intervention during labour and delivery. Observational studies have consistently demonstrated that obese women have a higher incidence of intrapartum complications. Compared to a non-obese parturient, an obese woman is more likely to have her labour induced and require instrumental delivery. Several studies have demonstrated a significant relationship between increasing maternal body mass index (BMI) and caesarean section (CS), with meta-analysis suggesting an odds ratio of 2.05 for obese women compared to those with a normal BMI. National recommendations are that urgency of caesarean section should be classified using a four point system. This classification of urgency does not suggest times for the decision to delivery interval (DDI). However it is a widely quoted audit standard that in a nonelective caesarean section (category 1 and 2) the baby should be delivered within 30 min of the decision to deliver. When considering whether this is a reasonable expectation in a morbidly obese parturient it is necessary to examine three key areas: