الفهرس 
physiological changes in pregnancy of a morbid obese parturientOnly 14 pages are availabe for public view
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Abstract
Obesity has become a public health epidemic in many nations worldwide, and is a serious health problem among reproductive-aged women. Morbid obesity and its comorbid conditions place the parturient and fetus at increased risk of complications related to pregnancy, surgery and anesthesia. [Vricella L, 2010] Obesity is linked to a number of co-morbidities, including type 2 diabetes, cancer and cardiovascular diseases. [Hanley, 2010] Morbid obesity accentuates the physiological changes associated with pregnancy. It is not uncommon in the morbidly obese parturient to see systolic and diastolic dysfunction of the left ventricle, pulmonary hypertension and obstructive sleep apnea. Moreover, endothelial dysfunction, a consequence of insulin resistance and dyslipidemias, may predispose these patients to pregnancy induced hypertension. [Wolf M, 2001]
The physiological and anatomical changes caused by both obesity and pregnancy increase the potential of an unanticipated difficult airway, impossible mask ventilation and rapid desaturation during the apneic phase. Morbidly obese patients undergoing open abdominal surgery are at increased risk for serious respiratory complications including pulmonary embolism, pneumonia, atelectasis, aspiration and respiratory failure [Yu CK, 2006].
Surgery in this patient population is considered high risk but careful planning, preoperative risk assessment, adequate anesthetic management, strict venothrombotic event prevention, and effective postoperative pain control will all help to reduce risk. [Ankichetty, 2012]