This survey had the objective to determine the frequency of the obesity at the parturient, to value the impact of the obesity on the childbirth by Caesarean and the complications postoperative immediate in the teaching hospitals of Cotonou. Patients and Method: We did a prospective, comparative and analytic survey from January 13 to April 13, 2012. Eight hundred ninety-one consecutive parturients having had a Caesarean were included. We studied the anesthetic techniques, the techniques of control of the aerial ways, the number of necessary tests for the tracheal intubation, the complications and aftercare of the first 48 hours. A comparison has been made according to the BMI. The obesity has been defined by a BMI ≥ 30 kg/m2. The parturient has been classified in two groups: Non-obese: BMI ≤ 30 kg/m 2, obese: BMI ≥ 30. Results: There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The obesity which has been recovered at 286 parturient is 32.10%. The obese parturient also required more frequently several lumbar punctures (p < 0.001) at the time of the spinal anesthesia and more of conversion of the spinal anesthesia into a general anesthesia (p = 0.008). The postoperative complications: laryngeal pain, back pain and suppuration of the wound were more frequent at the obese parturient. Conclusion: Many changes led by pregnancy are added to those of the obesity to drive to functional changes, a reduction of the physiological reserve and finally to an increased anesthetic and obstetric risk. The obesity is frequent at the parturient in Benin. The post-operative complications are more frequent after the Caesarean at the obese parturient.
According to a WHO’s report, more than a third of the women and a quarter of the men in Africa are in overweight, and these proportions should increase to 41% and 30% respectively during the next ten years. The recent tendencies in the urbanization of the developing countries and the internationalization of the food market contribute to changing the behavior of people and their style of life. These changes of lifestyle, bound to the nutrition, transition of the traditional to the modern habits, have driven to the emergence of the overweight and the obesity [
This survey had the objective to determine the frequency of the obesity at the parturient, to value the impact of the obesity on the childbirth by Caesarean and the complications postoperative immediate in the teaching hospitals of Cotonou.
Our survey took place in the service of anesthesia resuscitation, the operative blocks, to the intensive care, the delivery rooms, the services of hospitalization, the neonatology service of two academic motherhoods of Benin,. We did a prospective, comparative and analytic survey of January 13 to April 13, 2012. After the favorable opinion of the local ethics committee and the consent of the parturient. We collected the data by a standardized questionnaire. The information we collected included age, height, weight, BMI, Co-morbidities, gestational and parity, anesthetic technique, complications, indications for Caesarean section, cesarean section modalities , the satisfaction of the parturient. All parturients who had a Caesarian procedure during this study period were included either Eight hundred ninety-one parturients. We studied the anesthetic techniques, the techniques of control of the aerial ways, the number of necessary tests for the tracheal intubation, the complications and aftercare of the first 48 hours. A comparison has been made according to the BMI. The obesity has been defined by a BMI ≥ 30 kg/m2. The parturient has been classified in two groups: Non obese: BMI ≤ 30 kg/m2, obese: BMI ≥ 30. The obese have been classified in 4 groups: moderate obesity: BMI between 30 and 35 kg/m2; stern obesity: BMI splices 35 and 40 kg/m2; morbid obesity: BMI ≥ 40 kg/m2; terrific obese: BMI ≥ 50 kg/m2 [
The collected data have been seized with the help of the software SPSS 18 and have been analyzed with the software Epi-Info 3.3.2. The qualitative variables have been described while using the percentages and their interval of confidence. The quantitative variables have been described while using the average and the gap marks. The comparisons of frequency have been made with the help of the test of Chi Square and the comparisons of average with the test of Student. A p been worth lower or equal to 0.05 has been considered like statistically meaningful.
There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The obesity has been recovered at 286 parturient is 32.10%. Among the 286 obese, 57.69% (165) had an obesity moderates; 28.32% (81) had a stern obesity, 13% (37) had a morbid obesity and 1.04% (3) were terrific obese. The obese parturient had a more elevated middle gravidity to 3.03 and a more elevated middle parity to 1.56. The high BP, OSAS and the burrs were the co-morbidities the more frequently recovered at the obese parturient (
BMI < 30 | BMI ≥ 30 | p | |||
---|---|---|---|---|---|
Effective total | 605 | (67.90%) | 286 | (32.10%) | |
Age < 18 ans | 11 | 1.82% | 1 | 0.35% | 0.063 |
18 - 45 ans | 593 | 98.02% | 283 | 98.95% | 0.237 |
>45 ans | 1 | 0.17% | 2 | 0.7% | 0.243 |
Mean Gravidity | 2.66 ± 1.588 | 3.03 ± 1.803 | <0.001 | ||
Mean Parity | 1.28 ± 1.422 | 1.56 ± 1.653 | <0.001 | ||
Co-morbidity | |||||
Arterial hypertension | 108 | 17.85% | 76 | 26.57% | 0.002 |
Diabetes | 8 | 1.32% | 2 | 0.70% | 0.328 |
Asthma | 19 | 3.14% | 14 | 4.90% | 0.135 |
Snoring | 106 | 17.52% | 104 | 36.36% | <0.001 |
OSAS | 18 | 2.98 | 44 | 15.38% | <0.001 |
Cardiopathy | 6 | 0.99% | 7 | 2.45% | 0.085 |
Other | 81 | 13.39 | 30 | 10.49% | 0.132 |
OSAS: Obstructive sleep apnea syndrome.
There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The Caesarean was programmed more frequently at the obese parturient (p = 0.003) (
The spinal anesthesia and the general anesthesia was practiced with the same frequency at the obese parturient as non-obese (
The postoperative complications: laryngeal pain, back pain and suppuration of the wound were more frequent at the obese parturient (
BMI < 30 kg/m2 | BMI ≥ 30 kg/m2 | p | |||
---|---|---|---|---|---|
Type of Caesarian | |||||
Emergency | 494 | 81.65% | 209 | 73.08% | 0.003 |
Scheduled | 111 | 18.35% | 77 | 26.92% | 0.003 |
Indications | |||||
Dystocia | 168 | 27.77% | 76 | 26.57% | 0.386 |
Preeclampsia | 91 | 15.04% | 56 | 19.58% | 0.055 |
Eclamptic crisis | 48 | 7.93% | 16 | 5.59% | 0.13 |
Uterine scar | 151 | 24.96% | 78 | 27.27% | 0.255 |
PP | 31 | 5.12% | 20 | 6.99% | 0.281 |
Placenta hematoma | 18 | 2.98% | 6 | 2.18% | 0.304 |
UR | 35 | 5.79% | 11 | 3.85% | 0.144 |
Acute fetal distress | 171 | 28.26% | 68 | 23.78% | 0.091 |
Prophylactic | 50 | 8.26% | 26 | 9.09% | 0.384 |
Fetal macrosomia | 4 | 0.66% | 6 | 2.10% | 0.064 |
Other | 14 | 2.31% | 6 | 2.10% | 0.445 |
BMI < 30 | BMI ≥ 30 | P | |||
---|---|---|---|---|---|
Spinal anesthésia | 486 | 80.33% | 234 | 81.82% | 0.334 |
Multiple lumbarpunction | 290 | 47.93% | 192 | 67.13% | <0.001 |
Failure to lumbarpunction | 0 | 0.00% | 3 | 1.05% | 0.033 |
Severe low blood pressure | 118 | 19.50% | 57 | 19.93% | 0.474 |
Reconversion in general anesthésia | 13 | 2.15% | 16 | 5.59% | 0.008 |
General anesthesia | 119 | 19.67% | 52 | 18.18% | 0.334 |
Mallampati 1 | 311 | 51.40% | 61 | 21.30% | <0.001 |
Mallampati 2 | 183 | 30.20% | 36.4% | 0.041 | |
Mallampati 3 | 78 | 12.90% | 28.00% | <0.001 | |
Mallampati 4 | 33 | 5.50% | 14.30% | <0.001 | |
Multiple laryngoscopy | 43 | 7.11% | 36 | 12.59% | 0.006 |
Failure to intubation | 6 | 0.99% | 4 | 1.40% | 0.407 |
Laryngospasm | 1 | 0.17% | 0 | 0.00% | 0.313 |
Hypoxia | 77 | 12.73% | 41 | 14.34% | 0.287 |
Bronchial inhalation | 0 | 0.00% | 1 | 0.35% | 0.321 |
Cardiac arrest | 1 | 0.17% | 0 | 0.00% | 0.679 |
Pulmonary distress | 2 | 0.33% | 2 | 0.70% | 0.385 |
Late awakening | 5 | 0.83% | 5 | 1.75% | 0.385 |
BMI < 30 | BMI ≥ 30 | P | |||
---|---|---|---|---|---|
Post operatives headaches | 66 | 10.91% | 38 | 13.29% | 0.178 |
Post operatives nausea and vomiting | 88 | 14.55% | 52 | 18.18% | 0.099 |
Laryngeal pain | 28 | 4.63% | 22 | 7.69% | 0.047 |
Cough | 6 | 0.99% | 1 | 0.35% | 0.286 |
Neck pain | 6 | 0.99% | 4 | 1.40% | 0.407 |
Chills | 24 | 3.97% | 13 | 4.55% | 0.404 |
Lumbar pain | 11 | 1.82% | 12 | 4.20% | 0.034 |
Suppurating wound | 0 | 0.00% | 6 | 2.10% | 0.001 |
This survey permitted to determine the prevalence of the obesity at the parturient that benefitted from the Caesarean in the academic hospitals of Cotonou, and to determine the impact of the obesity on the complications of the Caesarean.
The prevalence of the obesity at these parturient was of 32.10%. It was superior to the 10.73% of the general population in the Benin [
Our survey was only carried on the parturient having benefitted a Caesarean and no on the set of the parturient. We could not define the frequency of Caesarean among the obese parturient in relation to the non-obese parturient. The obesity at the parturient is associated to affections as: the arterial hypertension, the diabetes, the asthma, the pre-eclampsia and the OSAS [
Many changes led by pregnancy are added to those of the obesity to drive to functional changes, a reduction of the physiological reserve and finally to an increased anesthetic and obstetric risk [
The laryngeal pains were more frequent at the obese that the non-obese. It explains itself comfortably by the number more raised of laryngoscopy. In the same way, there was more back pain at the obese that the non-obese. This result is only a consequence of the multiple lumbar punctures. The suppuration of the operative wound was observed solely at the obese parturient. What joins the observations of Lebuffe et al. [
Our survey reveals that the obesity’s frequency increased depending on the number of pregnancy and childbirth. Obesity increased the risk of occurred hypertension, apnea sleep syndrome and snoring. It increased the difficulties of lumbar puncture at a spinal anesthesia with an important risk of using the general anesthesia. Immediate complications due to obesity were postoperative wound suppurations and long-term back pain.
The authors declare no conflicts of interest regarding the publication of this paper.
Hode, A.K., Zoumenou, E., Hounkpatin, B., Mewanou, S., Tchaou, B. and Chobli, M. (2018) Complications of Obesity in Cesarized Parturients in the Teaching Centers of Cotonou. Open Journal of Endocrine and Metabolic Diseases, 8, 137-144. https://doi.org/10.4236/ojemd.2018.86014