Rare cesarean section, unable to perform spinal anesthesia for 178kg mother

béo phì - Ảnh 1. — The pregnant woman had such a thick layer of fat that even the longest anesthetic needle could not reach the anesthetic area - Photo: BVCC

Pregnant women face many complex risks

On August 15, the Central Obstetrics Hospital shared that it had just performed a cesarean section for an obese pregnant woman with many complicated medical conditions. Ms. D. was 37 weeks pregnant with her first child, obese, preeclamptic, and diabetic, and was transferred from Vinh Phuc Obstetrics and Pediatrics Hospital in a high-risk condition for both mother and fetus.

Ms. D. suffered from a metabolic disorder that led to uncontrolled weight gain, her weight before pregnancy was about 140kg and she gained an additional 38kg during pregnancy. With her large weight, along with preeclampsia and diabetes, normal delivery was almost impossible. Even the option of a cesarean section posed a series of dangerous risks in anesthesia, surgery and post-operative resuscitation.

Doctor Bach Minh Thu, in charge of the Department of Anesthesia and Resuscitation Surgery, Central Maternity Hospital, said that for obese patients, the thick layer of fat causes loss of anatomical landmarks, the distance from the skin to the subarachnoid space is too large, the existing anesthetic needle is almost not long enough, so the risk of regional anesthesia failure is very high even with the support of ultrasound.

"And in fact, when using an ultrasound machine to determine the anatomy, we recorded that this distance was up to more than 11cm - exceeding the maximum length of the anesthetic needle by quite a bit. Therefore, after spinal anesthesia was no longer possible, the team quickly switched to the endotracheal anesthesia plan that had been fully prepared in advance," Dr. Thu informed.

Dr. Thu added that the team performed the endotracheal intubation procedure according to the strategy of "not losing the airway", optimizing posture and maximizing oxygen reserve before anesthesia to reduce the risk of hypoxemia for the mother and fetus - a common complication in patients like this.

During the surgery, Dr. Dang Quang Hung, deputy head of the hospital's obstetrics and pathology department - who directly performed the surgery - said that the most difficult part of the surgery was the very thick abdominal wall, making it difficult to access the uterus and remove the fetus.

The sagging abdominal fat tissue makes the surgeon's operations much more difficult. On the background of hypertension and diabetes, the risk of surgical site infection and postoperative respiratory complications also increases significantly. During surgery, due to the large abdominal fat mass and the fetus compressing the diaphragm, the lungs are pushed up, making it difficult to expand, easily collapsing, and there is a risk of cardiopulmonary complications.

"The surgery therefore requires a smooth coordination between anesthesia and surgery to quickly and safely deliver the fetus, while "releasing" the hemodynamic burden on the mother," said Dr. Hung.

After nearly 1 hour, the surgery was successful. The baby boy weighed 3.4 kg, was rosy, cried loudly, and was transferred to the Neonatal Center for monitoring immediately after birth. However, although the mother's hemodynamics were stable, she still had to continue to face many respiratory risks, so she was closely monitored in the post-operative room.

In the postoperative room, the patient D. continued to be ventilated, then used muscle relaxants and extubated according to the correct procedure. Immediately after extubation, the patient was supported with non-invasive positive pressure ventilation and instructed in breathing exercises to optimize blood oxygenation and avoid lung collapse.

During the monitoring process, the pregnant woman responded well and met the conditions and was transferred to the emergency resuscitation department for further monitoring.

Obese women should be careful before getting pregnant.

Doctors recommend that women with obesity or metabolic disorders should be examined and counseled before pregnancy, develop a plan to control weight, blood pressure and blood sugar, and have a reasonable diet and lifestyle.

During pregnancy, you need to have regular check-ups on schedule, follow nutrition and exercise instructions according to professional instructions, and talk to your doctor early if there are any unusual signs (edema, rapid weight gain, headache, visual disturbances, high blood pressure, etc.).

Being examined and consulted from the beginning as well as promptly transferring to a specialized facility when there are risk factors will help ensure maximum safety for the mother and newborn.

WILLOW

Source: https://tuoitre.vn/ca-mo-lay-thai-hy-huu-khong-the-gay-te-tuy-song-cho-san-phu-nang-178kg-20250815093327713.htm