title: Impact of morbid obesity on epidural anesthesia complications in labor.
abstract: OBJECTIVE
  We sought to determine whether morbid obesity is associated with increased maternal hypotension or fetal heart rate (FHR) abnormalities after epidural anesthesia placement during labor.
  
  
  METHODS
  This was a retrospective cohort study of women undergoing epidural anesthesia during labor at term from April 2008 through July 2010.
  
  
  RESULTS
  A total of 125 morbidly obese patients were matched for age and race with 125 normal-weight patients. Morbidly obese patients had more frequent persistent systolic (16% vs 4%, P = .003) and diastolic (49% vs 29%, P = .002) hypotension and more prolonged (16% vs 5%, P = .006) and late (26% vs 14%, P = .03) FHR decelerations. Increasing body mass index was associated with persistent systolic (odds ratio, 1.06; 95% confidence interval, 1.02-1.10) and diastolic (odds ratio, 1.04; 95% confidence interval, 1.01-1.06) hypotension after controlling for epidural bolus dose and hypertensive disorders.
  
  
  CONCLUSIONS
  Morbidly obese women have more hypotension and prolonged FHR decelerations following epidural anesthesia during labor at term.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Vricella
authors.forename: Judette M
authors.initials: JM
authors.lastname: Louis
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Norman
authors.initials: N
authors.lastname: Bolden
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D009767:Obesity, Morbid / Q000150:complications*; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult