Anesthésie de la parturiente obèse

Due to the rapid increase in the incidence of obesity worldwide, anaesthesiologists are more frequently confronted to (morbidly) obese patients. Obesity increases the maternal, fetal and neonatal risks. During labour, these patients represent an obstetrical high risk population with increasing risk for induced and prolonged labour, complicated vaginal delivery and caesarean section in which the anaesthesiologist's involvement is required. On the other hand, anaesthesiologic procedures represent a technical challenge and are associated with an increasing risk for sometimes life-threatening complications. Most authors and opinion leaders agree that regional anaesthesia is the preferred technique for Caesarean section in obese patients and that efforts to place early labour epidural analgesia should be optimized in order to be able to avoid general anaesthesia when unplanned Caesarean section is required. Starting from the background of the normal physiological changes in vital functions during pregnancy and specific maladaptation in the obese, this review provides the clinician with a detailed and comprehensive overview on the relevant pathophysiology, epidemiology and clinical aspects of anaesthesia management in the obese parturient.