Table 5.

Recommendations Before, During, and After Surgery in Obese Pregnant Women

• Consider preoperative cardiac evaluation, especially if the patient has diabetes or chronic hypertension. This should include a baseline electrocardiogram and, if abnormal, an echocardiogram and cardiology consultation.

• Give preoperative broad-spectrum antibiotics 20–30 minutes before the skin incision to reduce the risk of postpartum endometritis and wound infection.

• Consider using a large operating table (especially if the patient is < 300 lb) and having additional personnel in the delivery room.

• Because of the increased risk of intrapartum blood loss, consider having additional blood products available in the operating room.

• If indicated, tape the pannus out of the surgical field to facilitate visualization and avoid a through-and-through skin incision.

• Close the subcutaneous layer. There is extensive evidence that seroma formation and postoperative wound disruption can be decreased in obese women (defined as adipose layer < 2 cm) if the subcutaneous tissues are closed using layers of running sutures.

• Avoid subcuticular skin closure to allow serous fluids from the subcutaneous fat to drain out of the incision rather than accumulate in the subcutaneous layer.

• Place pneumatic compression stockings on the lower extremities of all obese parturients prior to and during surgery as prophylaxis against deep vein thrombosis (DVT).

• The compression stockings should remain in place until the patient is fully ambulatory. Additional prophylaxis against DVT with prophylactic low-molecular-weight heparin should be considered in women with a body mass index ≥ 40 kg/m2.

• Begin early ambulation to prevent DVT formation.

• Consider delaying removal of staples or sutures for a full week to allow the skin to heal completely.