Maternal and perinatal outcomes in obese parturients with epidural analgesia: a systematic review.

Objectives: Obesity in pregnancy is associated with several risks during vaginal delivery. Several guidelines advise early epidural placement. This systematic review summarizes evidence on the maternal and perinatal outcome of epidural analgesia (EA) for vaginal delivery in obese women.

Methods: A systematic literature search was conducted to identify studies reporting EA during vaginal delivery in obese women. Study information, baseline characteristics, and outcomes were extracted.

Results: Eleven studies (31,325 patients total) were included. Newcastle-Ottawa Scale quality scores ranged from 2/8 to 7/8. Studies varied in study group choice, baseline characteristics, and outcome measures. Five studies reported patient-oriented outcomes, nine reported technical outcomes regarding catheter placement. One study compared obese women with early vs. late vs. no EA and reported similar incidence of instrumental deliveries (5.3 vs. 1.8 % vs. 0 %, p=0.315) and similar Apgar scores (8.37 ± 1.17 vs. 8.43 ± 1.28 vs. 8.08 ± 2.02, p=0.519). Other studies used a comparison of obese with non-obese women, both receiving EA. Incidence of instrumental deliveries was similar, but the incidence of cesarean delivery and several other outcomes was increased in obese women.

Conclusions: The selected literature predominantly reports on technical difficulties regarding EA. In many studies but one, we found a sub-optimal comparison of obese and non-obese women with EA. Side effects of EA in obese women are suggested in some studies, but we believe that the true influence of EA in obese parturients is insufficiently reported. To fully understand associated risks and benefits for these women, this population should be studied separately, and more evidence is needed.